Master Hypercalcemia (OLD VERSION) with Picmonic for Nursing RN

Hypercalcemia is defined as a serum calcium level higher than 10.5 mg/dL. Because the normal range is narrow, even slight increases can have severe effects.

In most cases, the excess calcium in the blood was leached from the bones, which weakens them. This can lead to pathologic fractures.

Hypercalcemia decreases neuromuscular excitability, with the most common symptom presenting as lethargy. Fatigue, confusion, and a decreased level of consciousness may be observed with severe cases leading to coma.

Hypercoagulation, otherwise known as the formation of blood clots, can occur more easily in states of hypercalcemia. The patient is at increased risk for developing deep vein thrombosis (DVT) of the lower extremities or in areas where venous obstruction occurs.

Hypercalcemia can cause constipation due to decreased peristalsis. Patients may also experience nausea, vomiting, anorexia, and abdominal pain. 

Hypercalcemia results in EKG changes, which includes a shortened QT interval and shortened ST segment. Cardiovascular changes are the most serious and life-threatening problems of hypercalcemia and should be treated immediately.

Hypercalcemia causes increased cardiac contractility, and increased heart rate. This translates into shorter ventricle depolarization and repolarization times, which when viewed on ECG is a shortened QT interval.

Interventions for hypercalcemia aim to reduce serum calcium levels thus, no calcium intake should be permitted. This includes stopping IV solutions containing calcium such as Ringer’s lactate and oral drugs containing calcium.

Calcium chelating drugs are those that bind to calcium thereby lowering serum levels. Examples include plicamycin (Mithracin) and penicillamine (Cuprimine, Pendramine).

Calcitonin is a drug used to inhibit calcium resorption from bone and thereby helps to prevent hypercalcemia.

Thiazide diuretics are discontinued and replaced with diuretics that promote the excretion of calcium, such as furosemide (Lasix).

As the calcium builds up in the body, crystals can form in the kidneys. Over time, the crystals may combine to form renal calculi or kidney stones.

Fluid volume replacement can aid in restoring normal serum calcium levels. Fluids should be increased if not contraindicated and may include the infusion of IV normal saline as sodium increases kidney excretion of calcium.