Lecture on Hypercalcemia

Key Concepts

Definition

• Hypercalcemia: High calcium levels in the blood (above 10.5 mg/dL).
• Calcium roles: Keeps the 3Bs strong (Bones, Blood, Heartbeats).

Functions of Calcium

• Bones: Ensures bone strength.
• Blood: Enhances clotting factors.
• Heartbeats: Regulates heart contractions and rhythm.

Regulation of Calcium

1. Parathyroid Hormone (PTH): Increases calcium concentration in the blood.
2. Calcitonin: Decreases blood calcium by storing it in bones.
3. Calcitriol: Inhibits calcitonin, releasing calcium from bones into the bloodstream.

Calcium Relationships

• Magnesium: Calcium’s BFF; they work closely together.
• Phosphate: Calcium’s enemy; inversely related (when phosphate is low, calcium is high and vice versa).

Causes of Hypercalcemia

• Acronym: HAM (Calcium going all HAM in the gym)
  • H: Hyperparathyroidism (increases calcium).
  • A: Anti-acids containing calcium (e.g., Tums).
  • M: Malignant Cancer cells releasing calcium.
  • Also, Low Phosphate levels increase calcium.

Symptoms of Hypercalcemia

• Swollen and slow 3Bs (Bones, Blood, Heartbeats).
• Cardiovascular:
  • Decreased heart rate, respiratory rate, blood pressure.
  • EKG: Heart blocks, shortened QT interval, widened T waves.
  • Over-contraction of heart muscles.
• Respiratory: Shortness of breath, weak respirations.
• Gastrointestinal: Constipation, nausea, vomiting.
• Urinary: Kidney stones (renal calculi).
• Neurological:
  • Altered level of consciousness (ALOC).
  • Decreased deep tendon reflexes (DTRs).
• Muscular: Decreased excitability, muscle weakness, swollen/contracted muscles.
• Skeletal: Bone pain due to calcium being taken from bones.

Nursing Interventions

• Acronym: SLIM FAST
  • S: Safety from falls (fall precautions).
  • L: Lasix (Furosemide, loop diuretic) to excrete calcium.
  • I: IV phosphate to lower calcium levels.
  • M: Monitor EKGs, I&Os, kidney stones.
  • F: Fluids (e.g., normal saline) to dilute blood, prevent renal stones.
  • A: Avoid high calcium foods (LSF: Leafy greens, Sardines, Dairy).
  • S: Serious cases – Dialysis to remove excess calcium.
  • T: Treatment with Calcium Reabsorption Inhibitors (e.g., Calcitonin, Bisphosphonates).

Diet Recommendations

• LSD: Foods to avoid
  • L: Leafy Greens (spinach, collard greens).
  • S: Sardines, tofu.
  • D: Dairy products (cheese, milk, yogurt).

Medical Treatments

• Dialysis: For serious cases to wash out excess calcium.
• Calcium Reabsorption Inhibitors: Calcitonin, Bisphosphonates.
• Prostaglandin Inhibitors: Aspirin, NSAIDs (Ibuprofen).

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