endocrine and metabolic disorders
Hypercalcemia
Symptoms and Signs of Hypercalcemia
In mild hypercalcemia, many patients are asymptomatic. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal pain, and ileus. Impairment of the renal concentrating mechanism leads to polyuria, nocturia, and polydipsia. Elevation of serum calcium>12 mg/dL (>3.00 mmol/L) can cause emotional lability, confusion, delirium, psychosis, stupor, and coma. Hypercalcemia may cause neuromuscular symptoms, including skeletal muscle weakness. Hypercalciuria with nephrolithiasis is common. Less often, prolonged or severe hypercalcemia causes reversible Acute Kidney Injury (AKI) or irreversible kidney damage due to nephrocalcinosis (precipitation of calcium salts within the kidney parenchyma). In severe hypercalcemia a shortened QTc interval is shown on ECG, and arrhythmias may occur, particularly in patients takingdigoxin. Hypercalcemia>18 mg/dL (>4.50 mmol/L) may cause shock, renal failure, and death. 