Calcium Disorders, High or Low
Calcium Disorders, High or Low
Calcium is a vital nutrient that supports many of our bodily functions. Calcium is needed to move muscles, circulate blood, help regulate hormones, aid in children’s growth and development, and more. However, too much or too little can wreak havoc on our body’s essential functions, so we must strike the right balance.
Our bodies cannot make calcium, so we must get it from our foods and our supplements. Calcium carbonate and calcium citrate are the two most recommended forms of calcium supplements. The recommended amount depends on your age and sex. Too much or too little calcium can lead to minor and major health problems, even life-threatening ones.
Hypocalcemia is a common calcium deficiency disorder that results in low calcium, and hypercalcemia is a common disorder that causes too much calcium in the blood.
Hypercalcemia can cause osteoporosis, kidney failure, kidney stones, and weaken bones. It is potentially a life-threatening condition because it can disrupt the brain and heart functions, even causing cardiac arrest (heart attack) or coma.
Researchers estimate that hypercalcemia affects more than 200,000 people each year in the United States. Those most at risk of developing hypercalcemia include people who are 50 and older, and it is more common in women than men. Other risk factors include:
- Lifestyle – not drinking enough water, sedentary, lack of exercise.
- Some medications – diuretics or lithium (more than 20% of people who take lithium get hypercalcemia).
- Overactive parathyroid glands – this is the most common cause of hypercalcemia.
- Some other medical disorders – tuberculosis, sarcoidosis, Paget’s disease, and overactive thyroid.
- Those with a family history of hypercalcemia – also known as familial hypocalciuric hypercalcemia (FHH).
- Taking too many supplements – calcium, vitamin D, and vitamin A.
- Having cancer – especially breast cancer, lung cancer, blood cancers, and cancers that have metastasized to your bones. Some cancer cells can secrete a parathyroid-like protein which mimics the parathyroid hormone. Researchers estimate that 10% to 30% of cancer patients will experience hypercalcemia.
Hypocalcemia is a calcium deficiency. Without enough calcium, our bodies cannot build strong bones, teeth, grow hair and fingernails, regulate the heart, and help other muscles function correctly. Children need calcium to grow to their full potential height as adults.
Those most likely to experience hypocalcemia include:
- Newborn babies, especially very small babies
- Children born to diabetic mothers
- Babies who drink too much cow’s milk, or formula with too much phosphate
- Women who are experiencing hormonal changes as they age
Other causes of hypocalcemia include:
- Hypoparathyroidism – this hormonal disorder is probably the most common cause of hypocalcemia, where the parathyroid glands do not produce enough parathyroid hormone, which controls calcium levels in the blood.
- Malnutrition – having a poor diet causes an insufficient intake of calcium and vitamin D.
- Malabsorption – is the body’s inability to absorb minerals properly, causing a vitamin D, calcium, or magnesium deficiency.
- Medications – such as bisphosphonates, lithium, corticosteroids, rifampin, phenobarbital, phenytoin, calcium channel blockers, and other medicines can decrease calcium absorption.
- Genetics – those who have a family history of hypocalcemia are at a higher risk of developing it themselves.
- Cancer – such as breast cancer, blood cancer, lung cancer, and cancer that has metastasized to the bone can cause a calcium deficiency.
- Other medical conditions – such as diabetes, sarcoidosis, pancreatitis, hypermagnesemia, hypomagnesemia,hyperphosphatemia, septic shock, tuberculosis, liver disease, kidney failure, rhabdomyolysis, and tumor lysis syndrome can prevent the body’s ability to regulate calcium.
- Digestive disorders – such as constipation and diarrhea, affect the body’s ability to absorb calcium from foods properly.
- Low levels of albumin – a protein that helps to carry calcium in the blood can cause hypocalcemia. Malnutrition or liver disease can cause low levels of albumin. Both liver disease and malnutrition can result from alcoholism or other illnesses. Low albumin is common in people who are acutely ill.
- Massive blood transfusions – frequently cause hypocalcemia due to the presence of the anticoagulant citrate in each unit of blood.
- Alcoholism – can prevent the body from adequately metabolizing minerals like calcium, vitamin D, and magnesium.
Calcium Disorders, High or Low Symptoms
Some symptoms of hypercalcemia and hypocalcemia are similar. For example, either can cause memory loss, confusion, and depression. But there are other symptoms specific to low calcium vs. high calcium, and signs of hypocalcemia may be different for newborns vs. adults and children. Some of these other symptoms are listed below:
Those with mild hypercalcemia may have no symptoms. However, those with higher levels of calcium, or who experience a rapid onset, may experience:
- Abdominal pain
- Bone pain
- Difficulty sleeping
- Extreme thirst
- Frequent urination
- Muscle pain
Hypocalcemia in Adults and Children
Early-stage or mild hypocalcemia may not cause any symptoms. However, symptoms will develop if the condition progresses. Symptoms of hypocalcemia in adults and children include:
- Mood changes
- Slow heartbeat
- Slow hair growth
- Coarse Hair
- Weak nails
- Brittle nails
- Fragile, thin skin
- Dry skin
- Muscle cramps
- Muscle spasms
- Muscle weakness
- Numbness/tingling in lips or face
- Numbness/tingling in hands
- Numbness/tingling in feet
- Facial twitches
- Slow heartbeat
- Difficulty swallowing (dysphagia)
- Easily broken bones
Hypocalcemia in Newborns
Symptoms of hypocalcemia to look for in newborns include:
- Apnea or slowed breathing
- Tachycardia or a fast heartbeat
- Poor feeding
Contact your pediatrician right away if your infant or child is demonstrating signs of hypocalcemia.
Calcium Disorders, High or Low Diagnosis
Diagnosis of hypercalcemia begins with a doctor’s visit, where you will receive an examination, have your medical history taken, and talk about your symptoms. Your doctor will probably recommend blood and urine tests to determine your serum calcium and vitamin D levels. If hypercalcemia is detected, more tests will be performed to detect the cause and identify any complications it might have caused. The doctor may order the following tests:
- A parathyroid scan to see if the parathyroid glands are overactive
- An MRI to rule out other medical conditions
- A CT scan to see if another medical condition caused hypercalcemia
Diagnosis begins with a medical history and an examination that may include a study of hair, skin, muscles, and possibly gently tapping a set of facial nerves in the cheeks to check for a twitching response. Your doctor will ask about symptoms and any family history of calcium deficiency. There may be a mental exam to check for signs of dementia, confusion, hallucinations, irritability, or seizures. If the doctor suspects a calcium disorder, blood tests will be ordered.
If initial blood tests confirm the diagnosis of hyper or hypocalcemia, then your doctor must determine the cause. Additional blood tests may be necessary to check the level of:
- Vitamin D
- Alkaline phosphatase
- Parathyroid hormone
- Complete blood count (CBC)
- “Ionized” calcium (measures calcium not bound to albumin)
Your doctor may also order urine tests to check for calcium, phosphates, and other electrolytes. Depending upon symptom severity, an EKG may be necessary to ensure the heart rhythm is functioning correctly.
Calcium Disorders, High or Low Treatments
If hypercalcemia is mild, the doctor might choose to watch and wait, monitoring your kidneys and bones regularly to make sure they stay healthy. However, for more severe hypercalcemia, the doctor will recommend treatment. These treatments may include medicines for treatment of the underlying cause, and in some cases, surgery may be necessary.
Your doctor might recommend one or more of the following medications:
- Bisphosphonates – Hypercalcemia due to cancer may be treated with Intravenous osteoporosis medications that can quickly lower calcium levels.
- Calcimimetics – This type of drug helps control overactive parathyroid glands.
- Calcitonin (Miacalcin) – This hormone comes from salmon and controls calcium levels in the blood.
- Denosumab (Prolia, Xgeva) – Doctors may prescribe this medication to people with hypercalcemia caused by cancer who respond poorly to bisphosphonates.
- IV fluids and diuretics – Because excessive calcium levels can be a medical emergency, hospitalization might be necessary for treatment with IV fluids and diuretics to quickly correct calcium blood levels.
- Steroids – If high levels of vitamin D are the cause of hypercalcemia, short-term use of a steroid such as prednisone may be helpful.
- Surgical and other procedures
Frequently, hypercalcemia is the result of one or more malfunctioning parathyroid glands. If the parathyroid glands are affected, the medical team will use a scanning test to identify which gland or glands aren’t working correctly and may remove it or them. Removing the affected glands usually cures hypercalcemia.
Depending on the cause, a calcium deficiency is usually easy to treat. It typically involves simply adding more calcium to the diet. However, there are various types of calcium supplements. It is essential to follow your doctor’s instructions about the type and amount, so the diet is not over-supplemented with too much or the wrong kind of calcium. Because some medications can negatively interact with calcium supplements, the doctor needs to know what other medicines and other supplements you are currently taking.
If supplements and dietary changes aren’t sufficient in treating hypocalcemia, the doctor may order calcium injections. There is usually improvement within a few weeks of treatment. However, monitoring every one, two, or three months may be necessary to ensure hypocalcemia remains under control when the case is severe.
Also, other treatments may be necessary to address and correct the underlying cause of hypocalcemia.
Congenital Calcium Disorders, High or Low Specialists
Laurie Kane, MD
12555 West Jefferson Blvd., Suite 301, Los Angeles, CA 90066
Rose Lin, MD
1831 Wilshire Blvd., Suite A, Santa Monica, CA 90403
Sarah Rettinger, MD
1831 Wilshire Blvd., Suite A, Santa Monica, CA 90403