Republic of the Philippines CAMIGUIN POLYTECHNIC STATE COLLEGE Institute of Nursing Balbagon, Mambajao, Camiguin

HYPERCALCEMIA

Submitted to: Claudie C. Conzon, RN Clinical Instructor Submitted By: Ms. Patrice Quincy Dailo Ms.Lyra C. Jaquilmac BSN-3

Calcium Excess ( Hypercalcemia) - Excess in Calcium in Plasma Causes:  Hyperparathyroidism, a primary cause which increases serum calcium levels by promoting calcium absorption from the intestine, resorption from bone, and reabsorption from the kidneys.  Hypervitaminosis D, which can promote increased absorption of calcium from the intestine.  Some cancers, such as multiple myeloma, lymphoma, squamous cell carcinoma of the lung, and breast cancer, which raise serum calcium levels by destroying bone or by releasing PTH or a PTH- like substance, osteoclast-activating factor, prostaglandins and, perhaps, a vitamin D- like sterol.  Multiple fractures and prolonged immobilization, which release bone calcium and increase the serum calcium level.  Other causes of hypercalcemia include milk-alkali syndrome, renal failure, sarcoidosis, hyperthyroidism, adrenal insufficiency, thiazide diuretics, and excessive administration of calcium during cardiopulmonary arrest. Complications:  Inhypercalcemia, serum calcium levels greater than 13.5 mg/dl may cause coma and cardiac arrest.  Hypercalcemia may also lead to renal calculi.

Assessment Findings:  A patient with hypercalcemia may have a history of risk factors, such as excessive ingestion of vitamin D and prolonged immobilization.  He may complain of lethargy, weakness, anorexia, constipation, nausea, vomiting, and polyuria. Family members may report personality changes.  During assessment, the patient may appear confused or, in severe cases, comatose.  Neuromuscular assessment may reveal muscle weakness, with hyporeflexia and decreased muscle tone. Diagnostic Test:  Total serum calcium levels are greater than 10.5 mg/dl in hypercalcemia.  Ionized serum calcium levels greater than 5.3mg/dl confirm hypercalcemia.  Sulkowitchs urine test shows increased calcium precipitation in hypercalcemia.  Electrocardiogram results are significant for shortened QT interval is seen. Verticulararrythmias may occur with severehyercalcemia. Treatment:  Treatment for patients with hypercalcemia that produces no symptoms may consist only managing the underlying cause.

 Treatment ofhypercalcemia that produces symptoms primarily eliminates excess serum calcium through hydration with normal saline solution; w/c promotes calcium excretion in urine.  Loop diuretics, such as ethacrynic acid and furosemide, also promote calcium excretion.  Corticosteroids, such as prednisone and hydrocortisone, are helpful in treating sarcoidosis, hypervitaminosis D, and certain tumors.  Mithramycin can also lower serum calcium levels and is especially effective against hypercalcemia secondary to certain tumors.  The administration of I.V. phosphates is potentially dangerous and is used only when other treatments prove in effective. Nursing Intervention:  Monitor serum calcium levels frequently. Report increasing levels.  Increase fluid intake to dilute calcium in serum and urine and to prevent renal damage and dehydration.  Watch for signs of heart failure in patients receiving normal saline solution diuresis therapy.  Administer loop diuretics (not thiazide diuretics) as ordered. Monitor intake and output, and strain urine for renal calculi. Provide acid-ash drinks, such as cranberry juice, because calcium salts are more soluble in acid than in alkali.

 Check ECG results and vital signs frequently. Observe for arrhythmias if hypercalcemia is severe.  If the patient is receiving a digitalis glycoside, watch for signs of toxicity, such as anorexia, nausea, vomiting, and an irregular pulse.  Ambulate the patient as soon as possible. Handle the patient with chronic hypercalcemia gently to preposition him frequently, and encourage rangeof-motion exercises to promote circulation and prevent urinary stasis and calcium loss from bone.  Provide a safe environment. Keep the beds side rails raised and the bed in the lowest position with the wheels locked.