Hypercalcemia in Cancer

Electrolyte imbalance is a common occurrence in cancer patients. The calcium levels for instance may also increase. The normal level of calcium in the blood is between 4.5-5.5 mEq/L. High calcium levels may mean that the cancer cells have reached the bones. It may break the bones in time and eventually, calcium will be deposited since there is no regeneration happening anymore.

Causative Factors:

  1. Origin of the cancer such as bone cancer
  2. Metastasis to the musculoskeletal system.
  3. Cancers that have hypercalcemia naturally
  4. Hyper parathyroidism
  5. Medications that may have side effects concentrated to hypercalcemia. Use of diuretics, alkaline antacids, estrogen and progesterone are examples.

Stages of Hypercalcemia and its Manifestations:

1. Mild hypercalcemia – People generally are asymptomatic at this stage. Only when the serum electrolytes are examined, calcium levels will be known. Some of the physical symptoms such as nausea, faster satiety, vomiting and slow bowel movement may also signal that the calcium levels will tend to increase.

2. Moderate hypercalcemia – An individual with moderate hypercalcemia will complain of sudden tiredness or easy fatigability. Electrocardiogram will be helpful in detecting cardiac rhythm abnormalities pointing to electrolyte imbalance. Urinary urgency and frequency can also be seen as the kidney stones block the ducts.

3. Severe hypercalcemia – In this case, sudden behavioural symptoms can be observed such as muscle twitching, confusion and changes in personality. Individuals may also become anxious at this point as the calcium levels are high enough to affect the brain activities.

Diagnostic Evaluation:

  1. A complete serum electrolyte test is requested. This may give a quick picture of the status of the calcium level in the blood.
  2. Electrocardiography is also advised in order to trace the heart activity. Any abnormality can be pointed out immediately with the rhythm emitted by the heart.
  3. Cranial CT Scan are done in order to rule some neurologic anomalies.
  4. Kidney, ureter and bladder ultrasound can be done in order to check if there is stone formation already.

Medical Management:

  1. Inform the individual to always rehydrate in order to dissolve the calcium accumulation thus preventing calcium stone formation.
  2. Comply with medications prescribed such as anti-emetic drugs as well as anti-diarrheal medications.
  3. Note the frequency of bowel movement as well as vomiting episodes. Replace the lost fluids volume per volume.
  4. Higher levels of calcium may be the point for admission. Intravenous introduction of diuretics are advised in order to take out the excess calcium from the system.
  5. Biphosphates also prevent bone breakdown in cancer patients. Cancer cells as they metastasis on the bone destroy the osteoclasts that are responsible in bone regeneration. With introduction of biphosphates, fractures and bone pain can be reduced.
  6. Increase in activities of daily living can also use up the calcium deposits. It is encouraged that mobilization can naturally stop the accumulation of calcium in the bloo

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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