What is the syndrome of hypercalcemia, the symptoms and treatment of the condition?
Mar 21, 2018
If the disease in question is mild, then there will be no significant clinical manifestations. If the increase in the level of calcium in the blood proceeds in moderate or severe degree, the patient will note the following symptoms:
- general weakness;
- mild depression;
- the retardation;
- violation of orientation in space and environment;
- impaired consciousness( right up to coma).
At a high level of calcium in the blood, clear symptoms from the cardiovascular system will be determined:
- sure increase in blood pressure;
- cardiac arrhythmia;
- sudden cardiac arrest.
In case of pathological damage to the organs of the urinary system, there will be an increase in the volume of excreted urine, and if the pathology is neglected, the volume will decrease.
Symptoms of digestive system damage in hypercalcemia syndrome:
- nausea and vomiting;
- disorders of stool( there are, in the main, constipation);
- decreased appetite, up to the total refusal of food;
- pains in the epigastric region, the left hypochondrium of the shingles that occur immediately after ingestion.
In the case of prolonged course of hypercalcemia, the patient can develop calcification of kidney structures, calcium will be deposited in the cells of the vessels, skin, lungs, heart and stomach.
Note: most often get sick to the doctor with complaints of pain in the joints and bones.It is in this case that specialists conduct examinations and identify hypercalcemia.
The most dangerous condition develops with a hypercalicemic crisis.It is characterized by nausea and constant / uncontrolled vomiting, severe pain in the abdomen, convulsions, sudden increase in body temperature.Consciousness of the patient in this case will be confused, which ends with a stupor and coma.Unfortunately, in most cases, it is impossible to save a patient with the rapid development of a hypercalcemic crisis.
Diagnosis is not only to specifically identify the disease in question - it is important to find out the cause that led to such a violation.To suspect a syndrome of hypercalcemia, a doctor can, based on the patient's complaints and comparing them with the presence of an oncological disease in an anamnesis.But also these data do not allow to make the diagnosis, the patient must undergo a full-fledged examination.As a rule, experts recommend taking blood tests to determine the level of total calcium( the study is done twice) and determining the level of free calcium.
In order for the results of the survey to be as reliable as possible, the patient must follow certain rules:
- Do not consume alcoholic beverages the day before the scheduled study.
- Avoid heavy physical activity 30 hours before the scheduled appointment.
- From food three days prior to the test, products with a high calcium content are excluded, as this can "smear" the results.
- For 8 hours the patient must completely stop eating.
If the blood tests for the level of total and free calcium revealed that the indices are too high, then the doctor will have to find out the true cause of such a pathology. For this, the patient will be assigned an additional examination:
- urine analysis to determine the amount of calcium excreted with it;
- blood test for the presence of bone metabolism;
- urine test to detect or confirm the absence of the Bence-Jones protein in it;
- blood test for PTH and PTH-like peptides;
- biochemical blood test with emphasis on renal tests.
If hypercalcemia syndrome is associated with an oncological pathology, the patient will be diagnosed with a reduced level of phosphate in the blood, an elevated level of PTH-like peptides, but in urine a normal or slightly above normal level of calcium in the urine will be detected.
If the syndrome in question is associated with myeloma, the Bens-Jones protein will be detected in the urine, and in the blood - a high level of ESR and a normal level of phosphate.
When performing diagnostic activities, instrumental methods can also be used:
- ultrasound examination of the kidneys;
- radiography of bones;
- densitometry( allows to diagnose osteoporosis).
Treatment of hypercalcemia
Hypercalcemia, which occurs in a severe degree, requires the provision of prompt, qualified medical care.
If the doctor "sees" a serious degree of the condition in question, the patient is placed in a hospital and a number of intensive care measures are performed:
- abolition of all medications that even theoretically can raise the level of calcium in the blood;
- is intravenously administered to the patient with physiological saline until complete compensation of the deficit in the body of the fluid and restoration of the normal volume of excreted urine;
- forced diuresis with furosemide;
Note: can result in a decrease in the level of potassium and magnesium in the blood resulting from the administration of furosemide, so the doctor must constantly monitor the content of these trace elements.
- for cardiac or renal insufficiency to conduct infusion therapy is strictly contraindicated, therefore patients are prescribed peritoneal dialysis or hemodialysis;
- intravenous injection of bisphosphonates - drugs that reduce the level of calcium in the blood;
- administration of calcitonin by intramuscular, intravenous or subcutaneous route.
Treatment of mild and moderate hypercalcemia
When a patient's condition is docked, therapeutic measures do not stop - they continue, but in a different volume. The patient is assigned:
- pamidronic acid intravenously drip 1 time in a month and a half for 2-5 years;
- calcitonin - daily, by subcutaneous or intramuscular injection;
- glucocorticosteroids - for example, prednisolone;
- mitomycin is an antitumor drug that is prescribed only if hypercalcemia is present against an oncological disease;
- gallium nitrate - is administered intravenously, it helps to lower the rate of calcium release from the bones.
If the patient has been diagnosed with asymptomatic or mild hypercalcaemia, then infusion therapy is not performed, but bisphosphonates are administered orally.
The syndrome of hypercalcemia is a condition that poses a certain danger to the health and even life of a person.Any specific forecasts doctors do not give to such patients - it all depends on what the underlying disease is.In some cases, to normalize the level of calcium in the blood, it is enough to cancel the medications, in many cases the condition in question requires life-long medication to correct the level of calcium in the blood.
Tsygankova Yana Aleksandrovna, medical reviewer, therapist of the highest qualification category