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Hypercalcemia
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Hypercalcemia

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Contributors: Peter Joo, Abhijeet Waghray MD, Paritosh Prasad MD, Eric Ingerowski MD, FAAP
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Synopsis

Hypercalcemia is elevated serum calcium concentration and is most commonly caused by drugs, malignancy, and primary hyperparathyroidism. Patients present with stones (renal or biliary), bones (bone pain), abdominal moans (abdominal pain, nausea, and vomiting), and psychic groans (decreased concentration, confusion, fatigue, stupor, and coma). Cardiovascular consequences can also ensue, manifesting as cardiac arrhythmias due to a truncated QT interval.

Drug-induced hypercalcemia can be due to excessive drug consumption (vitamin A, vitamin D, or thiazide diuretics). Calcium absorption (or bone resorption) exceeds the excretion of calcium, resulting in excess calcium in the blood. Less commonly associated medications include lithium (due to increased secretion of parathyroid hormone [PTH]), teriparatide, theophylline (mild toxicity via beta-adrenergic regulation), and certain topical ointments.

Non-drug-induced causes are parathyroid disorders, specific malignancies such as solid tumors (commonly lung, breast, ovarian, kidney, and pancreatic primary tumors), carcinomas with or without bone metastases, hematologic cancers (leukemia, lymphoma, myeloma, etc), granulomatous diseases (sarcoidosis, tuberculosis, granulomatosis with polyangiitis, histoplasmosis, coccidioidomycosis, silicosis, berylliosis, Pneumocystis pneumonia, and Nocardia infection), chronic liver disease, renal insufficiency, kidney transplant, bacteriosis, parenteral feeding, and familial hypocalciuric hypercalcemia.

Rare causes include dehydration, pheochromocytoma, acute adrenal insufficiency, Paget disease, Williams syndrome, and prolonged immobilization.

Codes

ICD10CM:
E83.52 – Hypercalcemia

SNOMEDCT:
66931009 – Hypercalcemia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Causes of hypercalcemia:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 07/26/2019
Last Updated: 07/26/2019
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Hypercalcemia
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Hypercalcemia (Moderate) : Abdominal pain, Headache, Nausea/vomiting, Constipation, Malaise, Polyuria, Anorexia, Polydipsia, Ca elevated
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