Hypercalcemia is a dangerous condition for the body, and even a slight excess of its value, recognized as the norm, requires attention. Excess calcium can adversely affect the function of most organs, including the most important ones such as the brain, kidneys and heart.
Hypercalcemia - what is it?
Hypercalcemia is a condition where the concentration of calcium in the blood is too high. This element plays an important role in the proper functioning of the body. Even children know about it. Parents, teachers encourage them to drink milk and explain that it contains a trace element, thanks to which they will grow and have he althy and strong bones. In the human body, 99% of calcium resources are found in the bones and only 1% in the blood. The trace element affects not only the bones, but also the proper functioning of the heart, muscles, nervous system and the blood coagulation process. But with excessive ingestion of calcium carbonate s alts and an excess of hydrochloric acid in the stomach, there is an increased absorption of the element from the intestine andits reduced excretion through the kidneys. If this condition is chronic, it leads to calcium deposition on the cornea, kidneys, gastric mucosa, connective tissue surrounding the joints, and the vascular wall.
Hypercalcemia and cancer
In the course of many neoplastic diseases, processes of destruction of the bone structure occur. Osteolysis causes bone metastases. Often bone cancer occurs as a result of multiple myeloma, oncology of the breast, prostate, lung cancer, thyroid cancer, bladder cancer. Bone metastases can also occur with other tumors.
Reasons
The most common causes of excess calcium are:
- Excessive absorption of an element from the gastrointestinal tract.
- Vitamin D overdose.
- Endogenous production of vitamin D by cells in certain tumors (eg Hodgkin's disease) or in chronic diseases (eg sarcoidosis).
- Excessive bone mobilization.
- Bone tumors.
- Excessive secretion of parathyroid hormone, growth hormone, thyroxine, adrenaline.
- Long-term immobilization leads to increased calcium excretion from bones.
- Hypervitaminosis A.
- Using drugs such as thiazides.
- Iron poisoning.
Tumor tissue can secrete parathyroid hormone (PTH), which leads to excess calcium. Symptoms in womenhypercalcemia usually appears in breast cancer, ovarian cancer and kidney cancer.
Classification
The clinical distribution of hypercalcemia depending on the concentration of calcium in the blood is as follows:
- light (< 3.2 mmol/l);
- moderate (3, 2-3, 4 mmol/l);
- heavy (> 3.4 mmol/L).
Hypercalcemic crisis is a life-threatening condition (≧ 3.7 mmol/L).
Research with excess calcium in the blood
- The concentration of ionized calcium is a more accurate marker of the severity of hypercalcemia. The laboratory norm is 1-1.3 mmol/L.
- Concentration of creatinine, chlorides, phosphates, magnesium to assess kidney function.
- PTH concentration.
- Concentration of vitamin D metabolites.
- Alkaline phosphatase concentration for assessing bone resorption.
If excess calcium is accompanied by low PTH levels, you should consider whether cancer is the cause. To clarify this situation, you should contact an oncologist as soon as possible.
If hypercalcemia is accompanied by elevated PTH levels, hyperparathyroidism is most likely the cause. To cure the disease, it is better to consult an endocrinologist.
Symptoms
Hypercalcemia itself is a symptom of many serious diseases, and the effects on internal organs can be dangerous and irreversible.
Symptoms of excess calcium:
- impaired kidney function: causes polyuria, dehydration, increased excretion of the element in the urine, which leads to kidney stones;
- Gastrointestinal disorders: nausea, vomiting, loss of appetite, constipation, peptic ulcer of the stomach or duodenum, acute pancreatitis. Very often there is a metallic taste in the mouth;
- cardiovascular symptoms: hypertension, tachycardia (increased heart rate), arrhythmia (irregular heartbeat),
- symptoms of the central nervous system: headache, drowsiness, even coma;
- neuromuscular symptoms: muscle weakness, facial paralysis.
If the concentration of a microelement in the blood exceeds 3.7 mmol/l, a hypercalcemic crisis occurs. This is a set of dangerous symptoms with impaired consciousness, severe abdominal pain, vomiting and nausea, polyuria leading to dehydration, arrhythmias (ECG changes can even mimic a heart attack) and coma.
Treatment
After detecting symptoms of excess calcium in the body, the cause (disease) should be determined and the condition treated. After therapy, it is recommended to repeat laboratory tests to check the effects of treatment.
Therapy should begin by giving the body plenty of fluids. A 0.9% NaCl solution is best used because elevated serum calcium is often accompanied by hyponatremia. It is estimated that with advanced hypercalcemia, the fluid deficit is 3-6 liters. Usually3-4 liters of 0.9% NaCl is administered in the first 24 hours, and in the following days - 2-3 liters / 24 hours. Good hydration is essential to improve renal flow and allows Furosemide to lower serum calcium, but this is only effective in 15% of patients. The amount of fluid should be adjusted individually depending on the state of circulation and kidneys. Sometimes subcutaneous irrigation (hypodermolysis) is used instead of oral or intravenous administration.
The next step in the fight against hypercalcemia is the use of bisphosphonates to reduce osteoclast activity. Particularly effective are nitrogen bisphosphonates, i.e. pamidronate, alendronate and zolendronate and clodronate.
Calcitonin is another drug that lowers serum calcium levels. It interferes with the function of osteoclasts and stops the reabsorption of the trace element in the tubules of the kidneys. An increase in its excretion leads to a rapid therapeutic effect. Due to the short-term effect caused by tachyphylaxis, which often occurs after a week, calcitonin is used only at the beginning of treatment or in combination with a bisphosphonate. Combination therapy is recommended for hypercalcemia above 3.5 mmol/l. The use of corticosteroids is recommended mainly in case of overproduction of vitamin D3. Routine use of oral phosphates is not recommended due to the potential for tissue calcification and diarrhea.
Radioactive isotopes (their administration) - another method of treatment for hypercalcemia caused by cancerdiseases. They selectively accumulate in the bones due to their affinity for phosphorus compounds and destroy cancer cells by irradiating them. Unlike classical radiation therapy, radiation is focused only in the immediate vicinity of the skeleton, which avoids irradiation of he althy tissues. Isotopes of strontium, iodine, phosphorus and yttrium are used. Iodine is mainly used to treat bone metastases in thyroid and prostate cancer. The most commonly used isotope of strontium effectively reduces pain in 80% of patients, the analgesic effect lasts six months or more.
Symptomatic treatment
The main goal of symptomatic treatment is to relieve symptoms associated with hypercalcemia. Maintenance therapy affects not only the quality, but also the life expectancy of patients with bone metastases. The most common cause of symptomatic treatment is the onset of pain. These pains are constant, they are often severe and negatively affect the comfort of the patient's life. In the treatment of pain, a three-step so-called analgesic ladder is used. The beginning of treatment is carried out with narcotic drugs with a gradual increase in their dose and the transition to the next group of drugs if the pain persists. It is very important to follow your doctor's instructions and take your medicines at specific times. Pain medications are recommended along with supportive medications. These include anticancer drugs (steroids).
Calcium Excess and Diet: Which Foods to Avoid?
In the treatment of hypercalcemia, an appropriate diet is also recommended - low in calcium and rich in phosphorus. Phosphates increase the release of trace elements from the body. People with this condition should limit their intake of yellow cheese, cottage cheese, white beans, and sesame seeds.
According to doctors, an excess of calcium carbonate in the joints can be triggered by the constant use of hard water with a high content of this element. Hard water also leads to the formation of kidney and bile duct stones. Therefore, it is recommended to drink filtered soft water and restrict drinking mineral water, which also contains many trace elements.
It should be remembered that such a diet contributes to obesity, so small but regular meals are recommended. By eliminating calcium, you must remember to provide the body with the remaining essential nutrients such as protein, fats, carbohydrates, vitamins and mineral s alts.
