Hypercalcemia Clinical Presentation

Updated: Apr 26, 2023
  • Author: Mahendra Agraharkar, MD, MBBS, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The mnemonic "stones, bones, abdominal moans, and psychic groans" describes the constellation of symptoms and signs of hypercalcemia. These may be due directly to the hypercalcemia, to increased calcium and phosphate excretion, or to skeletal changes.

The presentation in a patient with hypercalcemia varies with how fast and how far the calcium level rises, as well as the sensitivity of the individual to elevated calcium levels. Mild prolonged hypercalcemia may produce mild or no symptoms, or recurring problems such as kidney stones. Sudden-onset and severe hypercalcemia may cause dramatic symptoms, usually including confusion and lethargy, possibly leading quickly to death.

Central nervous system effects include the following:

  • Lethargy
  • Weakness
  • Confusion
  • Coma

Renal effects include the following:

  • Polyuria
  • Nocturia
  • Dehydration
  • Renal stones
  • Renal failure

Gastrointestinal effects include the following:

  • Constipation
  • Nausea
  • Anorexia
  • Pancreatitis
  • Gastric ulcer

Cardiac effects include syncope from arrhythmias.


Physical Examination

Most patients with hypercalcemia do not have any specific findings on physical examination. Those with higher calcium levels may have findings that are more striking. Evidence of the underlying cause may be found, such as a suggestive breast mass in someone with hypercalcemia secondary to malignancy.

Nervous system findings include the following:

  • Confusion
  • Hypotonia
  • Hyporeflexia
  • Paresis
  • Coma

Renal findings include the following:

  • Volume depletion
  • Signs of renal failure

Gastrointestinal findings include the following:

  • Fecal impaction (from constipation)
  • Signs of pancreatitis
  • Signs of malignancy (eg, enlarged liver or masses)

Cardiovascular findings include the following:

  • Arrhythmias
  • Hypotension

Ophthalmic findings may include band keratopathy, which is calcium precipitation in a horizontal band across the cornea in the palpebral aperture.