Hypercalcemia

Case study

BSN 3 Y 1 - 6 Anthony Ramos

 Group Members

Benedict francisco jherico josef gumaru david walter lising

jerome manabat matt rzel gabriel manalili auri el godfrey pangan

shaira mae de guzman kyla mae gatbonton fatri ci a rose hernandez

shannen bansil liwag jamila zia mahinay sophia matawaran

moira andrea reyes

Case:

A 50-year-old man presented at another hospital with non-specific

symptoms such as anorexia, nausea, vomiting, polyuria, dehydration,
abdominal pain, weight loss, fatigue, muscular weakness, irritability and
lethargy. Serum levels of calcium and parathyroid hormone (PTH) were
markedly increased to 23.6 mg/dL (reference values 8.6-10.2 mg/dL) and >
1900 ng/L (reference values 14-72 ng/L) respectively. After initial treatment,
the patient was transferred to the intensive care unit (ICU) of a tertiary
care university hospital for further stabilization and treatment because the
typical signs of hypercalcemia were not resolving. A parathyroid adenoma
was diagnosed and a few days later a parathyroidectomy was performed.
The postoperative course was uneventfuland the patient could be
discharged from the hospital in a good general condition.
Pathophysiology and Clinical Manifestations and Diagnostic Findings:

The condition of hypercalcemia refers to an elevated blood calcium level.

Blood calcium levels that are too high can affect the heart and brain function as
well as damage the bones and cause kidney stones. In addition to mediating
processes including nerve conduction, muscle contraction, coagulation,
electrolyte and enzyme regulation, and hormone release, calcium also plays a
significant role in intracellular and extracellular metabolism. A number of
hormones that influence calcium's entrance into the extracellular space from
bone and the GI tract as well as its excretion from the kidneys strictly regulate
calcium metabolism.
There may be minimal to no symptoms if the hypercalcemia is mild. The
signs and symptoms of more severe cases are related to the bodily parts
impacted by the excessive calcium levels in the blood. Effects include:
Pathophysiology and Clinical Manifestations and Diagnostic Findings:

• Kidneys - The kidneys must work harder to filter excess calcium. This could
result in frequent urination and excessive thirst.
• Digestive System - Constipation, nausea, vomiting, and stomach discomfort
can all be brought on by hypercalcemia.
• Bones and Muscles - The excess calcium in the blood was typically leached
from the bones, weakening them. Both bone pain and muscle weakening may
result from this.
• Brain - Confusion, sluggishness, and exhaustion are symptoms of
hypercalcemia, which can affect how the brain functions. Depression may also
result from it.
• Heart - Extreme hypercalcemia can affect how well the heart works, resulting in
palpitations, dizziness, signs of cardiac arrhythmia and other heart issues.
Regular blood tests, which include a calcium blood test, such as a
comprehensive metabolic panel (CMP) or basic metabolic panel (BMP),
frequently reveal hypercalcemia. These tests enable medical professionals to
spot calcium levels that are excessively high at an early stage.
Pathophysiology and Clinical Manifestations and Diagnostic Findings:

Mild: 10.5 to 11.9 mg/dL.

Moderate: 12.0 to 13.9 mg/dL.

Severe or crisis: 14.0 to 16.0 mg/dL.

A blood test called a comprehensive metabolic panel (CMP) examines 14 distinct

chemicals in the blood. It gives crucial details on the chemical balance and
metabolism of the body. Basic metabolic panel (BMP) does the same but only 8
different substances.
Medical Management:

Calcitonin (Miacalcin)
Calcimetics
Bisphosphonates
Denosumab (Prolia, Xgeva)
Prednisone
IV fluids and diuretics
Nursing Management:

1. Keeps patients hydrated (it reduces chance of kidney stone formation).

2. Protect the patient from falls and injuries (which can lead to bone calcium
loss).
3. Monitor cardiac, gastric, renal and neurological conditions.
4. Check for complaints of flank or abdominal pain and strain urine to look for
stone formation.
5. Reduce calcium-rich foods such as yogurt, sardines, cheese, spinach, tofu, and
milk, as well as calcium preservatives such as thiazides, dietary supplements,
and vitamin D.
6. Administer calcium reuptake inhibitors such as calcitonin, bisphosphonates,
and prostaglandin synthesis inhibitors.
FDAR
NCP
Thankyou!!!