Cardiac dysrhythmias, profound bradycardia, or heart block - obtain ECG and notify provider immediately.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A client with hypercalcemia (calcium 13 mg/dL) is admitted. Which clinical manifestation does the nurse expect?
Answer: A. Hypercalcemia depresses neuromuscular activity, causing muscle weakness, decreased deep tendon reflexes, constipation, lethargy, and a shortened QT interval. Tetany and hyperactive reflexes occur with hypocalcemia.
Question 2 of 4
A client has a serum calcium of 12.6 mg/dL. Which clinical manifestation should the nurse expect?
Answer: B. Hypercalcemia (normal 8.6-10.2 mg/dL) depresses neuromuscular excitability, producing muscle weakness, lethargy, constipation, and decreased deep tendon reflexes. Tetany, hyperactive reflexes, and a positive Trousseau sign are signs of HYPOcalcemia, not hypercalcemia.
Question 3 of 4
A client with a serum calcium of 11.8 mg/dL reports constipation and fatigue. Which additional finding should the nurse assess for?
Answer: A. Hypercalcemia decreases neuromuscular excitability, causing decreased deep tendon reflexes, muscle weakness, constipation, and a risk of renal calculi from elevated calcium.
Question 4 of 4
The nurse reviews a serum calcium of 13.0 mg/dL. Which assessment finding is consistent with this result?
Answer: A. Calcium of 13.0 mg/dL is critically high (normal 9-10.5). Hypercalcemia depresses neuromuscular activity, causing muscle weakness, decreased deep tendon reflexes, constipation, and lethargy.
Keep the streak going with more questions like these, each with a full rationale.
What is hypercalcemia?
Excess calcium depresses neuromuscular excitability, slowing the body down. Memory aid: 'bones, stones, groans, and psychiatric overtones' - bone pain, kidney stones, abdominal/GI complaints, and altered mental status. High calcium is the opposite of low calcium, so reflexes and muscle tone are decreased.
Key points to remember
- Calcium decreases neuromuscular excitability, causing muscle weakness, decreased deep tendon reflexes, and lethargy.
- Cardiac effects include a shortened QT interval and risk of bradycardia, heart blocks, and dysrhythmias.
- GI signs include anorexia, nausea, vomiting, constipation, and abdominal pain from decreased smooth muscle tone.
- Excess calcium is excreted by the kidneys, leading to polyuria, dehydration, and formation of renal calculi.
- Bone pain and pathologic fractures occur as calcium is pulled from bone, especially in hyperparathyroidism and cancer.
- Severe hypercalcemia causes confusion, decreased level of consciousness, and possible coma.
Common causes
- Hyperparathyroidism, cancer/bone mets
- Immobility, thiazides, ↑ vit D
Signs & symptoms
- 'Stones, bones, groans, moans'
- Muscle weakness, ↓ reflexes, lethargy
- Constipation, kidney stones, N/V
Nursing priorities
- Promote fluid intake and administer isotonic saline IV to dilute calcium and promote renal excretion.
- Increase mobility and weight-bearing activity, since immobility worsens bone calcium loss.
- Administer ordered medications such as bisphosphonates, calcitonin, or loop diuretics (furosemide) to lower calcium.
- Monitor cardiac rhythm, neuro status, and strain urine for renal calculi.
- Hold calcium and vitamin D supplements and limit high-calcium foods.
Labs & values
Patient teaching
- Stay well hydrated, around 3-4 liters per day if not restricted, to help prevent kidney stones.
- Stay physically active and weight-bear to keep calcium in bones.
- Avoid calcium supplements, antacids with calcium, and high-calcium foods unless told otherwise.
Red flags: report now
- Cardiac dysrhythmias, profound bradycardia, or heart block - obtain ECG and notify provider immediately.
- Severe lethargy progressing to decreased level of consciousness or coma (hypercalcemic crisis) is a medical emergency.
- Do not give thiazide diuretics, which raise calcium; loop diuretics are preferred when diuresis is needed.
References
Clinical references for this topic
