Hypercalcemia

Introduction:

Hypercalcemia is an abnormally high amount of calcium in the blood. Excess
intake of calcium (such as supplements or antacids) or altered excretion of calcium
(such as in patients with renal failure or those taking thiazide diuretics) may cause
hypercalcemia. Patients may also develop elevated calcium levels with prolonged
immobility, glucocorticoid use, hyperthyroidism, hyperparathyroidism, lithium
use, dehydration, or malignancies with metastasis to the bone.

PROGNOSIS
Correction of the calcium level is necessary to control the signs and symptoms.
Correction or management of the underlying disorder is necessary to correct the
abnormal calcium level. High calcium levels cause altered excitability of heart, skele-
tal, and smooth muscle tissues of the gastrointestinal tract, and nervous tissues.

SIGNS AND SYMPTOMS
• Increased heart rate initially
• Bounding peripheral pulses
• Bradycardia later as electrical conduction is slowed
• Sinus arrest then cardiac arrest due to altered response of cardiac tissue to
normal stimuli
• Shallow respirations due to skeletal muscle weakness
• Muscle weakness due to changes in neuromuscular response to normal stimuli
• Cardiac arrhythmias
• Nausea and vomiting due to decrease in peristaltic activity
• Constipation due to decrease in peristaltic activity
• Dehydration
• Kidney stones form as excess calcium deposits in kidneys; may be excreted
in urine

TREATMENT
Medications are typically used to reduce calcium levels. When levels are highly
elevated or patients are having life-threatening problems, dialysis may also be uti-
lized to reduce calcium levels.
• Stop all calcium-containing medications (supplements, antacids).
• Monitor cardiac rhythm.
• Maintain intravenous access.
• Administer 0.9 percent normal saline solution to ensure adequate hydration
status; sodium aids in urinary excretion of calcium.
• Administer Loop diuretics to enhance the excretion of calcium:
• furosemide
• Administer plicamycin, a calcium binder, to lower calcium levels.
• Administer calcitonin, phosphorus, bisphosphonates (etidronate, pamidronate
—to inhibit calcium resorption from the bone).

NURSING DIAGNOSES

• Ineffective breathing pattern
• Decreased cardiac output
• Impaired urinary elimination

NURSING INTERVENTION
• Monitor vital signs for changes.
• Monitor cardiovascular status for irregularity of heart rhythm, pulse deficit.
• Monitor intake and output.
• Assess muscle strength—hand grips, foot pushes bilaterally for strength and
equality.
• Assess abdomen for bowel sounds, distention, and pain.
• Encourage mobilization, assist with ambulation if necessary to decrease bone
resorption due to immobility.
• Assist with range-of-motion exercises.
• Low-calcium diet to reduce intake.
• Strain urine for stones.
• Explain to patient:
• High calcium foods.
• Avoid calcium supplements.
• Avoid calcium-based antacids.
• Weight-bearing exercise is important to avoid bone resorption.