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Beyond Normal Calcium: Why is Hypercalcemia a Medical Emergency?
Hypercalcemia, an abnormally elevated concentration of calcium ions in the serum, has become a medical emergency. According to research, the normal blood calcium range is 2.1 to 2.6 mmol/L, and conditions exceeding this value are defined as hypercalcemia. For those who experience a mild rise in calcium levels that develops slowly, there are usually no noticeable symptoms. However, when calcium concentration rises significantly or rapidly, it may cause severe symptoms such as abdominal pain, bone pain, confusion, depression, weakness, kidney stones, and even cardiac arrest.
There are various causes of hypercalcemia, among which primary hyperparathyroidism and cancer are the most important causes.
Symptoms and effects of hypercalcemia
Nervous system effects of hypercalcemia can lead to decreased responsiveness of muscle and nerve fibers integrated with the degree of calcium presence. Symptoms include decreased deep tendon reflexes (hyporeflexia), skeletal muscle weakness, and possible cardiac arrhythmias. Mentally, emotional instability, confusion, dementia, etc. may occur, and when high calcium levels exceed 15 to 16 mg/dL (i.e. 3.75 to 4 mmol/L), it is considered a dangerous medical emergency, which may lead to coma or Cardiac arrest.
Crisis and emergency response
When hypercalcemia reaches about 14 mg/dL (or 3.5 mmol/L), you enter a hypercalcemia crisis, which is an extremely serious emergency. In contrast to relatively mild hypercalcemia, this condition may result in decreased urine output and even lethargy or coma. When a crisis is detected, it is important to quickly assess whether it is caused by primary hyperparathyroidism. In some extreme cases, the only way to avoid death may require surgical removal of the parathyroid gland.
The diagnostic procedure needs to be completed within a few hours and is performed simultaneously with measures to lower serum calcium levels.
Causes of hypercalcemia
A fundamental understanding of hypercalcemia requires recognition of its various causes, such as primary hyperparathyroidism and malignant tumors, which account for approximately 90%. These causes can be divided into parathyroid hormone (PTH)-dependent and PTH-independent forms.
Primary hyperparathyroidism
Primary hyperparathyroidism is usually associated with parathyroid adenoma, parathyroid hyperplasia, or parathyroid carcinoma. The symptoms of this disease further exacerbate the accumulation of calcium in the blood and lead to a series of pathological changes.
Cancer
Another major cause of hypercalcemia is cancer, which is mainly caused by two mechanisms: tumor release of hormones that increase calcium and local osteolysis caused by bone marrow metastasis. Hormones released by certain tumors such as parathyroid hormone-related proteins can enhance calcium mobilization, thus exacerbating the hypercalcemic condition.
Diagnostic methods
Diagnosis of hypercalcemia primarily requires measurement of corrected calcium or ionized calcium levels, which need to be confirmed a week later. Because serum albumin levels influence the actual concentration of ionized calcium, a detailed medical history and appropriate testing must be performed to find the underlying cause of hypercalcemia. Typically, if symptoms are mild or asymptomatic, primary hyperparathyroidism or congenital hypocalciuric hypercalcemia is more likely.
Treatment Plan
The main goal in treating hypercalcemia is to first lower calcium concentrations and then treat the underlying cause. When the blood calcium level is higher than 13 mg/dL, or fluctuates rapidly and is accompanied by changes in mental status, intervention is urgently needed.
Treatment usually involves intravenous fluid replacement and may require diuretics, bisphosphonates, and other treatments.
During treatment, initial therapy is intravenous fluids, which help encourage the kidneys to excrete excess calcium. Bisphosphonates may subsequently be used to further reduce blood calcium concentrations, especially in patients with malignant tumors, for which their efficacy has been widely used.
Other considerations
Treatment of hypercalcemia not only involves the use of medications, but also requires consideration of the patient's overall health and possible complications. Particular caution should be exercised when functions such as carbohydrates, vitamin D, synovial cartilage, and kidneys are affected. Whether there are interactions with other ongoing treatments is also a factor to consider.
Hypercalcemia is a relatively common condition, but in the process of diagnosis and treatment, the most important thing is to intervene in time to avoid worsening of the condition. Are you concerned about your calcium balance?
