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Care During Chemotherapy and Beyond

Hypercalcemia (High Calcium)



What is Hypercalcemia?

Hypercalcemia is an electrolyte imbalance and is indicated by an excess of calcium in the blood.  The normal adult value for calcium is 4.5-5.5 mEq/L.

There are many reasons for an elevated blood calcium level.  Reasons for the hypercalcemia may include:

  • Cancer that started in the bone, or cancer that has spread to the bone.
  • Some cancers can cause hypercalcemia themselves, without spread to the bone.
  • Other conditions such as; overactive parathyroid gland or Paget's disease of the bone.
  • Some medications cause hypercalcemia such as: alkaline antacids, diethylstilbesterol (DES), long-term use of diuretics, estrogens and progesterone.

What Happens In Hypercalcemia?

Cancer cells that spread to the bone can secrete substances that can cause cells found in the bone called osteoclasts to dissolve or "eat away" a portion of the bone.  These tumors or lesions weaken the bone and can lead to complications.  Some of the complications resulting from this bone break down are bone pain, fractures and less commonly, hypercalcemia.

What Are Some Symptoms of Hypercalcemia To Look For?

  • Mild hypercalcemia may not produce any symptoms.  However, symptoms of nausea, poor appetite, vomiting and constipation may be present with mild increases in blood calcium levels.
  • Moderate high levels of hypercalcemia may produce fatigue or excessive tiredness.  Heart rhythm abnormalities, increased urinary frequency, and kidney stones may also be present.
  • With higher levels of hypercalcemia, patients may experience muscle twitching, anxiety, depression, personality changes and confusion. 
  • With very high levels of hypercalcemia excessive sleepiness, coma even death may occur.
  • The severity of symptoms for hypercalcemia depends not only on how high the calcium level is, but also on how fast the rise in serum calcium has occurred.

Things You Can Do If Your Blood Test Results Indicate Hypercalcemia:

  • It is important that you stay well hydrated.  Drink 2 to 3 quarts of fluid a every 24 hours, unless you are instructed otherwise. 
  • Take anti-nausea and anti-diarrhea medications as directed, also follow dietary recommendations.
  • Keep active, weight-bearing activities such as walking are helpful.  Being immobile aggravates hypercalcemia.

Drugs That May Be Prescribed By Your Doctor for Hypercalcemia:

  • If your blood test results show a seriously high blood calcium level, intravenous fluids with diuretics may be used to lower blood calcium levels quickly.
  • Bisphosphonates: These drugs, such as pamidronate, or zoledronate work by inhibiting bone loss.
    • Cancer cells that spread to the bone can secrete substances that can cause cells found in the bone called osteoclasts to dissolve or "eat away" a portion of the bone.  These tumors or lesions weaken the bone and can lead to complications.
    • Some of the complications resulting from this bone breakdown are bone pain, fractures and less commonly, hypercalcemia (increased levels of calcium in the blood).
    • Biphosphonate medications are used to slow down the osteoclast's effects on the bone.  In doing this it can be useful in slowing down or preventing the complications (bone pain, fractures, or hypercalcemia) of the bone breakdown.
  • Antineoplastic agents: Such as gallium nitrate, reduce bone turnover.
  • Antihypercalcemic agents: Such as calcitonin, work by inhibiting bone loss, and increasing the kidney's ability to get rid of calcium.

When to call your doctor or health care provider:

  • Nausea that interferes with your ability to eat, and is unrelieved by prescribed medication.
  • Diarrhea (4-6 episodes in a 24-hour period), unrelieved with taking anti-diarrhea medication and diet modification.
  • Abdominal pain, sweating, or fever (may be pancreatitis)
  • Any new rashes - if on new medications
  • Any unusual condition or problem that is concerning to you.

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Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.