What is Hypercalcemia ?

Hypercalcemia (high blood calcium levels) is a state where the concentration of calcium in the blood of more than 10.5 mgr / dL of blood.


CAUSE
Hypercalcaemia may be caused by increased absorption in the gastrointestinal tract as well as the increased intake of calcium. People who consume large amounts of calcium (as is sometimes done by people with peptic ulcers who drank lots of milk and also taking antacids that contain calcium), may suffer from hypercalcaemia.

An overdose of vitamin D can affect the blood calcium concentration, ie by increasing calcium absorption from the gastrointestinal tract. The most common cause of hypercalcemia is hyperparathyroidism, which is a situation where there is expenditure of parathyroid hormone on a large scale by one or more of the four parathyroid glands.

90% of patients with primary hyperparathyroidism have a benign tumor (adenoma) on one of the glans. The remaining 10% had an enlarged parathyroid glands produce too much hormone. In rare cases, cancer of the parathyroid glands causing hyperparathyroidism.

Hyperparathyroidism is more common in women than in men. Also more likely to occur in elderly people and in those who received radiation treatment to the neck. Sometimes hyperparathyroidism occurs as part of a multiple endocrine neoplasia syndrome, which is a rare hereditary disease.

People with cancer often have hypercalcemia. Kidney cancer, lung cancer or ovarian cancer (ovarian), often spend a large number of proteins that have effects similar to parathyroid hormone. This effect is known as paraneoplastic syndrome. Cancer has also spread (metastasize) to the bone, destroying the bone cells and bone calcium release into the blood. This often occurs in prostate cancer, breast and lung.

Multiple myeloma (a cancer involving the bone marrow) can also cause destruction of bone and cause hypercalcemia. Other cancers also increasing blood calcium concentrations, by a mechanism not yet fully understood.

In diseases where there is destruction or absorption of bone cells (eg Paget's disease), can also occur hypercalcaemia. People who are sedentary (eg people with paraplegia (paralysis of both lower body), kuadriplegia (all four limbs paralyzed) or lying in bed for a long time, can also suffer from hypercalcemia due to resorbed by bone tissue.


SYMPTOMS
The earliest symptoms of hypercalcemia usually is constipation (constipation), loss of appetite, nausea, vomiting and abdominal pain. The kidneys may be abnormal will produce urine in large quantities. Due to the formation of this excess urine, body fluids will be reduced and there will be symptoms of dehydration.

Severe hypercalcemia often causes symptoms of brain dysfunction such as confusion, emotional disturbances, delirium (decreased consciousness), hallucinations, weakness and coma. Can also be followed by an abnormal heart rhythm and death. In patients with chronic hypercalcaemia may develop kidney stones containing calcium. In the event of severe and chronic hypercalcemia, calcium crystals will form inside the kidneys and cause permanent damage.


Diagnosis
Hypercalcaemia is usually found during routine blood tests. The cause is often seen from the history of the patient and the latter activities (eg drinking milk and consuming large amounts of antacids that contain calcium tablets). To help determine the cause, conducted laboratory tests and x-rays.


TREATMENT
Treatment depends on the high blood calcium levels and causes. If the calcium concentration is not more than 11.5 mgr / dL of blood, the treatment simply by eliminating the cause. People who have normal kidney function and a tendency to hypercalcemia are usually advised to drink plenty of fluids that will stimulate the kidneys to excrete calcium and helps prevent dehydration.

When the calcium concentration is very high (more than 15 mgr / dL of blood) or when symptoms develop brain dysfunction, given intravenous fluids as long as the kidneys to function properly. Diuretic medications such as furosemide, increased disposal of calcium through the kidneys and is the primary therapy.

Dialysis therapy is highly effective, safe and reliable, and is usually performed on patients with severe hypercalcemia that can not be treated by other means. Hyperparathyroidism is usually treated with surgery to remove one or more parathyroid glands. So that the results are good, all tissues that produce parathyroid hormone in a very large amount must be removed
This operation success rate approaching 90%.

Several other drugs can be used to treat hipercalcemia when other methods fail to do:
- Plicamycin
- Gallium nitrate
- Calsitonin
- Biphosphonates
- Corticosteroid.

These drugs work primarily by slowing the removal of calcium from bone. Hypercalcaemia caused by cancer is difficult to treat. If the cancer can not be controlled, usually hypercalcemia will recur again despite the best treatment.