Hypercalcemia is defined as a total calcium level in the plasma greater than 2.6 mmol/L.
Mild hypercalcemia = 2.7 – 2.9 mmol/L Moderate hypercalcemia = 3.0 – 3.4 mmol/L Severe hypercalcemia = greater than 3.4 mmol/L Causes primary hyperparathyroidism malignancy excessive vitamin D intake thiazides or renal failure (secondary hyperparathyroidism) sarcoidosis multiple myeloma immobilization Clinical presentation Mild hypercalcemia - may be asymptomatic, nonspecific symptoms, such as constipation, fatigue, and depression Moderate hypercalcemia - polyuria, polydipsia, dehydration, anorexia, nausea, muscle weakness, and changes in sensorium Severe hypercalcemia - lethargy, confusion, stupor, coma and progression of symptoms above ECG manifestation short QT interval ST segment may be completely absent and replaced by inverted small T-wave directly after R-wave Osborn wave (usually a feature of hypothermia) - a positive deflection at the J point (negative in aVR and V1), most prominent in the precordial leads J-point elevation mimicking ST segment elevation is a common observation Ventricular irritability and VF arrest may occur in extreme hypercalcemia
Picture 1 QT interval in serum calcium abnormalities https://litfl.com/hypercalcaemia-ecg-library/
Picture 2 Osborn wave
ECG 1 Hypercalcemia (shortened QT interval, Osborn wave in V1)
Treatment depends on the severity of symptoms and the underlying cause.
avoid thiazide diuretics, prolonged inactivity, high calcium diet
adequate hydration minimises risk of nephrolithiasis saline hydration bisphosphonates calcitonin
References Kelwade JV, Modi KD, Kumar N, Parekh H. Hypercalcemia and electrocardiogram changes. Indian J Endocrinol Metab. 2016;20(6):892-893. doi:10.4103/2230-8210.192900 Elizabeth Shane, Clifford J Rosen, Jean E Mulder.Diagnostic approach to hypercalcemia.: https://www.uptodate.com/contents/diagnostic-approach-to-hypercalcemia Elizabeth Shane, Clifford J Rosen, Jean E Mulder.Clinical manifestations of hypercalcemia Elizabeth Shane, Clifford J Rosen, Jean E Mulder. Treatment of hypercalcemia. https://www.uptodate.com/contents/treatment-of-hypercalcemia https://litfl.com/hypercalcaemia-ecg-library/ https://www.techmed.sk/hyperkalcemia/ https://www.uptodate.com/contents/clinical-manifestations-of-hypercalcemia