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<ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> <li id="toc-Hypercalcaemic_crisis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hypercalcaemic_crisis"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Hypercalcaemic crisis</span> </div> </a> <ul id="toc-Hypercalcaemic_crisis-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Causes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Causes"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Causes</span> </div> </a> <button aria-controls="toc-Causes-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Causes subsection</span> </button> <ul id="toc-Causes-sublist" class="vector-toc-list"> <li id="toc-Parathyroid_function" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Parathyroid_function"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Parathyroid function</span> </div> </a> <ul id="toc-Parathyroid_function-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cancer" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cancer"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Cancer</span> </div> </a> <ul id="toc-Cancer-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Vitamin-D_disorders" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Vitamin-D_disorders"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Vitamin-D disorders</span> </div> </a> <ul id="toc-Vitamin-D_disorders-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-High_bone-turnover" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#High_bone-turnover"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>High bone-turnover</span> </div> </a> <ul id="toc-High_bone-turnover-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Kidney_failure" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Kidney_failure"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Kidney failure</span> </div> </a> <ul id="toc-Kidney_failure-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.6</span> <span>Other</span> </div> </a> <ul id="toc-Other-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-ECG" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#ECG"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>ECG</span> </div> </a> <ul id="toc-ECG-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatments" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatments"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Treatments</span> </div> </a> <button aria-controls="toc-Treatments-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatments subsection</span> </button> <ul id="toc-Treatments-sublist" class="vector-toc-list"> <li id="toc-Fluids_and_diuretics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fluids_and_diuretics"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Fluids and diuretics</span> </div> </a> <ul id="toc-Fluids_and_diuretics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bisphosphonates_and_calcitonin" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Bisphosphonates_and_calcitonin"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Bisphosphonates and calcitonin</span> </div> </a> <ul id="toc-Bisphosphonates_and_calcitonin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_therapies" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_therapies"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Other therapies</span> </div> </a> <ul id="toc-Other_therapies-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Other_animals" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Other_animals"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Other animals</span> </div> </a> <button aria-controls="toc-Other_animals-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Other animals subsection</span> </button> <ul id="toc-Other_animals-sublist" class="vector-toc-list"> <li id="toc-Household_pets" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Household_pets"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Household pets</span> </div> </a> <ul id="toc-Household_pets-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Outdoor_animals" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Outdoor_animals"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Outdoor animals</span> </div> </a> <ul id="toc-Outdoor_animals-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Hypercalcaemia</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 36 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-36" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">36 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%81%D8%B1%D8%B7_%D9%83%D8%A7%D9%84%D8%B3%D9%8A%D9%88%D9%85_%D8%A7%D9%84%D8%AF%D9%85" title="فرط كالسيوم الدم – Arabic" lang="ar" hreflang="ar" data-title="فرط كالسيوم الدم" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Hiperkalsemiya" title="Hiperkalsemiya – Azerbaijani" lang="az" hreflang="az" data-title="Hiperkalsemiya" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A5%D0%B8%D0%BF%D0%B5%D1%80%D0%BA%D0%B0%D0%BB%D1%86%D0%B8%D0%B5%D0%BC%D0%B8%D1%8F" title="Хиперкалциемия – Bulgarian" lang="bg" hreflang="bg" data-title="Хиперкалциемия" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Hipercalc%C3%A8mia" title="Hipercalcèmia – Catalan" lang="ca" hreflang="ca" data-title="Hipercalcèmia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Hyperkalz%C3%A4mie" title="Hyperkalzämie – German" lang="de" hreflang="de" data-title="Hyperkalzämie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Hipercalcemia" title="Hipercalcemia – Spanish" lang="es" hreflang="es" data-title="Hipercalcemia" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Hiperkalcemio" title="Hiperkalcemio – Esperanto" lang="eo" hreflang="eo" data-title="Hiperkalcemio" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%87%D8%A7%DB%8C%D9%BE%D8%B1%DA%A9%D9%84%D8%B3%D9%85%DB%8C" title="هایپرکلسمی – Persian" lang="fa" hreflang="fa" data-title="هایپرکلسمی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Hypercalc%C3%A9mie" title="Hypercalcémie – French" lang="fr" hreflang="fr" data-title="Hypercalcémie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Hipercalcemia" title="Hipercalcemia – Galician" lang="gl" hreflang="gl" data-title="Hipercalcemia" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B3%A0%EC%B9%BC%EC%8A%98%ED%98%88%EC%A6%9D" title="고칼슘혈증 – Korean" lang="ko" hreflang="ko" data-title="고칼슘혈증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%80%D5%AB%D5%BA%D5%A5%D6%80%D5%AF%D5%A1%D5%AC%D6%81%D5%A5%D5%B4%D5%AB%D5%A1" title="Հիպերկալցեմիա – Armenian" lang="hy" hreflang="hy" data-title="Հիպերկալցեմիա" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%85%E0%A4%A4%E0%A4%BF%E0%A4%95%E0%A5%88%E0%A4%B2%E0%A5%8D%E0%A4%B6%E0%A4%BF%E0%A4%AF%E0%A4%AE%E0%A4%B0%E0%A4%95%E0%A5%8D%E0%A4%A4%E0%A4%A4%E0%A4%BE" title="अतिकैल्शियमरक्तता – Hindi" lang="hi" hreflang="hi" data-title="अतिकैल्शियमरक्तता" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Hiperkalcijemija" title="Hiperkalcijemija – Croatian" lang="hr" hreflang="hr" data-title="Hiperkalcijemija" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Hiperkalsemia" title="Hiperkalsemia – Indonesian" lang="id" hreflang="id" data-title="Hiperkalsemia" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Ipercalcemia" title="Ipercalcemia – Italian" lang="it" hreflang="it" data-title="Ipercalcemia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%99%D7%A4%D7%A8%D7%A7%D7%9C%D7%A6%D7%9E%D7%99%D7%94" title="היפרקלצמיה – Hebrew" lang="he" hreflang="he" data-title="היפרקלצמיה" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%93%D0%B8%D0%BF%D0%B5%D1%80%D0%BA%D0%B0%D0%BB%D1%8C%D1%86%D0%B8%D0%B5%D0%BC%D0%B8%D1%8F" title="Гиперкальциемия – Kazakh" lang="kk" hreflang="kk" data-title="Гиперкальциемия" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Hiperkalsemia" title="Hiperkalsemia – Malay" lang="ms" hreflang="ms" data-title="Hiperkalsemia" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Hypercalci%C3%ABmie" title="Hypercalciëmie – Dutch" lang="nl" hreflang="nl" data-title="Hypercalciëmie" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E9%AB%98%E3%82%AB%E3%83%AB%E3%82%B7%E3%82%A6%E3%83%A0%E8%A1%80%E7%97%87" title="高カルシウム血症 – Japanese" lang="ja" hreflang="ja" data-title="高カルシウム血症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B9%E0%AC%BE%E0%AC%87%E0%AC%AA%E0%AC%B0%E0%AC%95%E0%AD%8D%E0%AD%9F%E0%AC%BE%E0%AC%B2%E0%AC%B8%E0%AD%87%E0%AC%AE%E0%AC%BF%E0%AC%86" title="ହାଇପରକ୍ୟାଲସେମିଆ – Odia" lang="or" hreflang="or" data-title="ହାଇପରକ୍ୟାଲସେମିଆ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Hiperkalcemia" title="Hiperkalcemia – Polish" lang="pl" hreflang="pl" data-title="Hiperkalcemia" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Hipercalcemia" title="Hipercalcemia – Portuguese" lang="pt" hreflang="pt" data-title="Hipercalcemia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%93%D0%B8%D0%BF%D0%B5%D1%80%D0%BA%D0%B0%D0%BB%D1%8C%D1%86%D0%B8%D0%B5%D0%BC%D0%B8%D1%8F" title="Гиперкальциемия – Russian" lang="ru" hreflang="ru" data-title="Гиперкальциемия" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Hypercalcemia" title="Hypercalcemia – Simple English" lang="en-simple" hreflang="en-simple" data-title="Hypercalcemia" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Hiperkalciemija" title="Hiperkalciemija – Slovenian" lang="sl" hreflang="sl" data-title="Hiperkalciemija" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A5%D0%B8%D0%BF%D0%B5%D1%80%D0%BA%D0%B0%D0%BB%D1%86%D0%B5%D0%BC%D0%B8%D1%98%D0%B0" title="Хиперкалцемија – Serbian" lang="sr" hreflang="sr" data-title="Хиперкалцемија" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Hiperkalcemija" title="Hiperkalcemija – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Hiperkalcemija" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Hyperkalsemia" title="Hyperkalsemia – Finnish" lang="fi" hreflang="fi" data-title="Hyperkalsemia" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Hyperkalcemi" title="Hyperkalcemi – Swedish" lang="sv" hreflang="sv" data-title="Hyperkalcemi" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Hiperkalsemi" title="Hiperkalsemi – Turkish" lang="tr" hreflang="tr" data-title="Hiperkalsemi" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%93%D1%96%D0%BF%D0%B5%D1%80%D0%BA%D0%B0%D0%BB%D1%8C%D1%86%D1%96%D1%94%D0%BC%D1%96%D1%8F" title="Гіперкальціємія – Ukrainian" lang="uk" hreflang="uk" data-title="Гіперкальціємія" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/T%C4%83ng_calci_m%C3%A1u" title="Tăng calci máu – Vietnamese" lang="vi" hreflang="vi" data-title="Tăng 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dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">High calcium (Ca2+) level in the blood serum</div> <p class="mw-empty-elt"> </p> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For the disorder of low blood calcium, see <a href="/wiki/Hypocalcemia" title="Hypocalcemia">Hypocalcemia</a>.</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Hypercalcemia</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Hypercalcaemia</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Ca-TableImage.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/6f/Ca-TableImage.svg/220px-Ca-TableImage.svg.png" decoding="async" width="220" height="66" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/6f/Ca-TableImage.svg/330px-Ca-TableImage.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/6f/Ca-TableImage.svg/440px-Ca-TableImage.svg.png 2x" data-file-width="671" data-file-height="202" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Calcium within the <a href="/wiki/Periodic_table" title="Periodic table">periodic table</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Abdominal_pain" title="Abdominal pain">Abdominal pain</a>, bone pain, <a href="/wiki/Confusion" title="Confusion">confusion</a>, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, <a href="/wiki/Weakness" title="Weakness">weakness</a><sup id="cite_ref-BMJ2015_1-0" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-0" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Kidney_stones" class="mw-redirect" title="Kidney stones">Kidney stones</a>, <a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">abnormal heart rhythm</a>, <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a><sup id="cite_ref-BMJ2015_1-1" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-1" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Primary_hyperparathyroidism" title="Primary hyperparathyroidism">Primary hyperparathyroidism</a>, <a href="/wiki/Cancer" title="Cancer">cancer</a>, <a href="/wiki/Sarcoidosis" title="Sarcoidosis">sarcoidosis</a>, <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>, <a href="/wiki/Paget%27s_disease_of_bone" title="Paget's disease of bone">Paget disease</a>, <a href="/wiki/Multiple_endocrine_neoplasia" title="Multiple endocrine neoplasia">multiple endocrine neoplasia</a>, <a href="/wiki/Vitamin_D_toxicity" title="Vitamin D toxicity">vitamin D toxicity</a><sup id="cite_ref-BMJ2015_1-2" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PMH2016_3-0" class="reference"><a href="#cite_note-PMH2016-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Blood_serum" class="mw-redirect" title="Blood serum">Blood serum</a> level > 2.6 mmol/L (<a href="/wiki/Corrected_calcium" class="mw-redirect" title="Corrected calcium">corrected calcium</a> or <a href="/wiki/Ionized_calcium" class="mw-redirect" title="Ionized calcium">ionized calcium</a>)<sup id="cite_ref-BMJ2015_1-3" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-2" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Underlying cause, <a href="/wiki/Intravenous_fluids" class="mw-redirect" title="Intravenous fluids">intravenous fluids</a>, <a href="/wiki/Furosemide" title="Furosemide">furosemide</a>, <a href="/wiki/Calcitonin" title="Calcitonin">calcitonin</a>, <a href="/wiki/Pamidronate" class="mw-redirect" title="Pamidronate">pamidronate</a>, <a href="/wiki/Hemodialysis" title="Hemodialysis">hemodialysis</a><sup id="cite_ref-BMJ2015_1-4" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-3" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data">See article</td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">4 per 1,000<sup id="cite_ref-BMJ2015_1-5" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Hypercalcemia</b>, also spelled <b>hypercalcaemia</b>, is a high <a href="/wiki/Calcium" title="Calcium">calcium</a> (Ca<sup>2+</sup>) level in the <a href="/wiki/Blood_serum" class="mw-redirect" title="Blood serum">blood serum</a>.<sup id="cite_ref-BMJ2015_1-6" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PMH2016_3-1" class="reference"><a href="#cite_note-PMH2016-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The normal range is 2.1–2.6 <a href="/wiki/Mmol/L" class="mw-redirect" title="Mmol/L">mmol/L</a> (8.8–10.7 mg/dL, 4.3–5.2 <a href="/wiki/MEq/L" class="mw-redirect" title="MEq/L">mEq/L</a>), with levels greater than 2.6 mmol/L defined as hypercalcemia.<sup id="cite_ref-BMJ2015_1-7" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-4" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-SI2005_4-0" class="reference"><a href="#cite_note-SI2005-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Those with a mild increase that has developed slowly typically have no symptoms.<sup id="cite_ref-BMJ2015_1-8" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In those with greater levels or rapid onset, symptoms may include <a href="/wiki/Abdominal_pain" title="Abdominal pain">abdominal pain</a>, bone pain, <a href="/wiki/Confusion" title="Confusion">confusion</a>, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, <a href="/wiki/Weakness" title="Weakness">weakness</a>, <a href="/wiki/Kidney_stones" class="mw-redirect" title="Kidney stones">kidney stones</a> or an <a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">abnormal heart rhythm</a> including <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>.<sup id="cite_ref-BMJ2015_1-9" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-5" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Most outpatient cases are due to <a href="/wiki/Primary_hyperparathyroidism" title="Primary hyperparathyroidism">primary hyperparathyroidism</a> and inpatient cases due to <a href="/wiki/Cancer" title="Cancer">cancer</a>.<sup id="cite_ref-BMJ2015_1-10" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Other causes of hypercalcemia include <a href="/wiki/Sarcoidosis" title="Sarcoidosis">sarcoidosis</a>, <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>, <a href="/wiki/Paget%27s_disease_of_bone" title="Paget's disease of bone">Paget disease</a>, <a href="/wiki/Multiple_endocrine_neoplasia" title="Multiple endocrine neoplasia">multiple endocrine neoplasia</a> (MEN), <a href="/wiki/Vitamin_D_toxicity" title="Vitamin D toxicity">vitamin D toxicity</a>, <a href="/wiki/Familial_hypocalciuric_hypercalcaemia" class="mw-redirect" title="Familial hypocalciuric hypercalcaemia">familial hypocalciuric hypercalcaemia</a> and certain <a href="/wiki/Medications" class="mw-redirect" title="Medications">medications</a> such as <a href="/wiki/Lithium_(medication)" title="Lithium (medication)">lithium</a> and <a href="/wiki/Hydrochlorothiazide" title="Hydrochlorothiazide">hydrochlorothiazide</a>.<sup id="cite_ref-BMJ2015_1-11" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-6" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PMH2016_3-2" class="reference"><a href="#cite_note-PMH2016-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Diagnosis should generally include either a <a href="/wiki/Corrected_calcium" class="mw-redirect" title="Corrected calcium">corrected calcium</a> or <a href="/wiki/Ionized_calcium" class="mw-redirect" title="Ionized calcium">ionized calcium</a> level and be confirmed after a week.<sup id="cite_ref-BMJ2015_1-12" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Specific changes, such as a shortened <a href="/wiki/QT_interval" title="QT interval">QT interval</a> and prolonged <a href="/wiki/PR_interval" title="PR interval">PR interval</a>, may be seen on an <a href="/wiki/Electrocardiogram" class="mw-redirect" title="Electrocardiogram">electrocardiogram</a> (ECG).<sup id="cite_ref-EU2010_2-7" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Treatment may include <a href="/wiki/Intravenous_fluids" class="mw-redirect" title="Intravenous fluids">intravenous fluids</a>, <a href="/wiki/Furosemide" title="Furosemide">furosemide</a>, <a href="/wiki/Calcitonin" title="Calcitonin">calcitonin</a>, intravenous bisphosphonate, in addition to treating the underlying cause.<sup id="cite_ref-BMJ2015_1-13" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-8" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> The evidence for furosemide use, however, is poor.<sup id="cite_ref-BMJ2015_1-14" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In those with very high levels, hospitalization may be required.<sup id="cite_ref-BMJ2015_1-15" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Haemodialysis" class="mw-redirect" title="Haemodialysis">Haemodialysis</a> may be used in those who do not respond to other treatments.<sup id="cite_ref-BMJ2015_1-16" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In those with vitamin D toxicity, <a href="/wiki/Steroids" class="mw-redirect" title="Steroids">steroids</a> may be useful.<sup id="cite_ref-BMJ2015_1-17" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Hypercalcemia is relatively common.<sup id="cite_ref-BMJ2015_1-18" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Primary hyperparathyroidism occurs in 1–7 per 1,000 people, and hypercalcaemia occurs in about 2.7% of those with cancer.<sup id="cite_ref-BMJ2015_1-19" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable" style="float: right; margin-left:15px; text-align:center"> <caption>Mnemonic for symptoms </caption> <tbody><tr> <td>Stones</td> <td><a href="/wiki/Nephrolithiasis" class="mw-redirect" title="Nephrolithiasis">Kidney</a> or biliary </td></tr> <tr> <td>Bones</td> <td>Bone pain </td></tr> <tr> <td>Groans</td> <td>Abdominal discomfort </td></tr> <tr> <td>Moans</td> <td>Complaints of <a href="/wiki/Non-specific_symptoms" class="mw-redirect" title="Non-specific symptoms">non-specific symptoms</a> </td></tr> <tr> <td><a href="/wiki/Toilet" title="Toilet">Thrones</a></td> <td><a href="/wiki/Constipation" title="Constipation">Constipation</a> and <a href="/wiki/Polyuria" title="Polyuria">excessive urination volume</a> </td></tr> <tr> <td>Muscle tone</td> <td>Muscle weakness, decreased reflexes </td></tr> <tr> <td>Psychiatric overtones</td> <td><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depression</a>, <a href="/wiki/Anxiety" title="Anxiety">anxiety</a>, cognitive dysfunction </td></tr></tbody></table> <p>The neuromuscular symptoms of hypercalcaemia are caused by a negative <a href="/wiki/Bathmotropic" title="Bathmotropic">bathmotropic</a> effect due to the increased interaction of calcium with <a href="/wiki/Sodium_channel" title="Sodium channel">sodium channels</a>. Since calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers, increased calcium raises the threshold for depolarization.<sup id="cite_ref-CMArmstrong1999_5-0" class="reference"><a href="#cite_note-CMArmstrong1999-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> This results in decreased <a href="/wiki/Deep_tendon_reflexes" class="mw-redirect" title="Deep tendon reflexes">deep tendon reflexes</a> (<a href="/wiki/Hyporeflexia" title="Hyporeflexia">hyporeflexia</a>), and skeletal <a href="/wiki/Muscle_weakness" title="Muscle weakness">muscle weakness</a>.<sup id="cite_ref-Merck2017_6-0" class="reference"><a href="#cite_note-Merck2017-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Other symptoms include <a href="/wiki/Cardiac_arrhythmias" class="mw-redirect" title="Cardiac arrhythmias">cardiac arrhythmias</a> (especially in those taking <a href="/wiki/Digoxin" title="Digoxin">digoxin</a>), <a href="/wiki/Fatigue_(physical)" class="mw-redirect" title="Fatigue (physical)">fatigue</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Vomiting" title="Vomiting">vomiting</a> (emesis), <a href="/wiki/Loss_of_appetite" class="mw-redirect" title="Loss of appetite">loss of appetite</a>, abdominal pain, & paralytic <a href="/wiki/Ileus" title="Ileus">ileus</a>. If <a href="/wiki/Kidney_impairment" class="mw-redirect" title="Kidney impairment">kidney impairment</a> occurs as a result, manifestations can include <a href="/wiki/Polyuria" title="Polyuria">increased urination</a>, <a href="/wiki/Nocturia" title="Nocturia">urination at night</a>, and <a href="/wiki/Polydipsia" title="Polydipsia">increased thirst</a>.<sup id="cite_ref-Merck2017_6-1" class="reference"><a href="#cite_note-Merck2017-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Psychiatric manifestation can include emotional instability, <a href="/wiki/Confusion" title="Confusion">confusion</a>, <a href="/wiki/Delirium" title="Delirium">delirium</a>, <a href="/wiki/Psychosis" title="Psychosis">psychosis</a>, and <a href="/wiki/Stupor" title="Stupor">stupor</a>.<sup id="cite_ref-Merck2017_6-2" class="reference"><a href="#cite_note-Merck2017-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Calcium deposits known as <a href="/wiki/Limbus_sign" title="Limbus sign">limbus sign</a> may be visible in the eyes.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Symptoms are more common at high calcium <a href="/wiki/Blood_values" class="mw-redirect" title="Blood values">blood values</a> (12.0 mg/dL or 3 mmol/L).<sup id="cite_ref-Merck2017_6-3" class="reference"><a href="#cite_note-Merck2017-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Severe hypercalcaemia (above 15–16 mg/dL or 3.75–4 mmol/L) is considered a <a href="/wiki/Medical_emergency" title="Medical emergency">medical emergency</a>: at these levels, <a href="/wiki/Coma" title="Coma">coma</a> and <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a> can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to <a href="/wiki/Hypotonicity" class="mw-redirect" title="Hypotonicity">hypotonicity</a> of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain <a href="/wiki/Drowsiness" class="mw-redirect" title="Drowsiness">drowsiness</a>, confusion, hallucinations, <a href="/wiki/Stupor" title="Stupor">stupor</a> or coma. In the gut this causes <a href="/wiki/Constipation" title="Constipation">constipation</a>. Hypocalcaemia causes the opposite by the same mechanism.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Hypercalcaemic_crisis">Hypercalcaemic crisis <span class="anchor" id="crisis"></span></h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=2" title="Edit section: Hypercalcaemic crisis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/L).<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>The main symptoms of a hypercalcaemic crisis are <a href="/wiki/Oliguria" title="Oliguria">oliguria</a> or <a href="/wiki/Anuria" title="Anuria">anuria</a>, as well as <a href="/wiki/Somnolence" title="Somnolence">somnolence</a> or <a href="/wiki/Coma" title="Coma">coma</a>.<sup id="cite_ref-Ziegler2001_10-0" class="reference"><a href="#cite_note-Ziegler2001-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> After recognition, primary <a href="/wiki/Hyperparathyroidism" title="Hyperparathyroidism">hyperparathyroidism</a> should be proved or excluded.<sup id="cite_ref-Ziegler2001_10-1" class="reference"><a href="#cite_note-Ziegler2001-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>In extreme cases of primary hyperparathyroidism, removal of the <a href="/wiki/Parathyroid_gland" title="Parathyroid gland">parathyroid gland</a> after surgical neck exploration is the only way to avoid death.<sup id="cite_ref-Ziegler2001_10-2" class="reference"><a href="#cite_note-Ziegler2001-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The diagnostic program should be performed within hours, in parallel with measures to lower serum calcium.<sup id="cite_ref-Ziegler2001_10-3" class="reference"><a href="#cite_note-Ziegler2001-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Treatment of choice for acutely lowering calcium is extensive hydration and <a href="/wiki/Calcitonin" title="Calcitonin">calcitonin</a>, as well as <a href="/wiki/Bisphosphonate" title="Bisphosphonate">bisphosphonates</a> (which have effect on calcium levels after one or two days).<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=3" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Primary_hyperparathyroidism" title="Primary hyperparathyroidism">Primary hyperparathyroidism</a> and malignancy account for about 90% of cases of hypercalcaemia.<sup id="cite_ref-Kumar_12-0" class="reference"><a href="#cite_note-Kumar-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-isbn0-07-147247-9_13-0" class="reference"><a href="#cite_note-isbn0-07-147247-9-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>Causes of hypercalcemia can be divided into those that are PTH dependent or PTH independent. </p> <div class="mw-heading mw-heading3"><h3 id="Parathyroid_function">Parathyroid function</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=4" title="Edit section: Parathyroid function"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>Primary hyperparathyroidism <ul><li><a href="/wiki/Solitary_parathyroid_adenoma" class="mw-redirect" title="Solitary parathyroid adenoma">Solitary parathyroid adenoma</a><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li>Primary parathyroid hyperplasia<sup id="cite_ref-Ranaghan_2018_15-0" class="reference"><a href="#cite_note-Ranaghan_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Parathyroid_carcinoma" title="Parathyroid carcinoma">Parathyroid carcinoma</a><sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Multiple_endocrine_neoplasia" title="Multiple endocrine neoplasia">Multiple endocrine neoplasia</a> (MEN1 & MEN2A)<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup></li> <li><a href="/w/index.php?title=Familial_isolated_hyperparathyroidism&action=edit&redlink=1" class="new" title="Familial isolated hyperparathyroidism (page does not exist)">Familial isolated hyperparathyroidism</a><sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup></li></ul></li> <li><a href="/wiki/Lithium_(medication)" title="Lithium (medication)">Lithium</a> use</li> <li><a href="/wiki/Familial_hypocalciuric_hypercalcemia" title="Familial hypocalciuric hypercalcemia">Familial hypocalciuric hypercalcemia</a>/familial benign hypercalcemia<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Cancer">Cancer</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=5" title="Edit section: Cancer"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Hypercalcemia of malignancy (cancer) is due to a variety of mechanisms. The two most common are humoral hypercalcemia of malignancy and local osteolytic hypercalcemia due to bony metastasis. Humoral hypercalcemia of malignancy involves the tumor releasing a hormone which increases calcium mobilization (most commonly <a href="/wiki/Parathyroid_hormone-related_protein" title="Parathyroid hormone-related protein">parathyroid hormone-related protein</a> (PTHrP)) into the circulation.<sup id="cite_ref-Guise_2022_22-0" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> PTHrP acts similarly to <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">parathyroid hormone</a> in that it binds to the <a href="/wiki/Parathyroid_hormone_1_receptor" title="Parathyroid hormone 1 receptor">parathyroid hormone 1 receptors</a> on the kidneys and bones and causes an increased <a href="/wiki/Renal_tubule" class="mw-redirect" title="Renal tubule">tubular</a> reabsorption of calcium and activation of <a href="/wiki/Osteoclast" title="Osteoclast">osteoclast</a> activity, respectively.<sup id="cite_ref-Guise_2022_22-1" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Osteoclasts are a type of bone cell which cause bone resorption, releasing calcium into the bloodstream. PTHrP also acts by activating <a href="/wiki/Rank_ligand" class="mw-redirect" title="Rank ligand">rank ligand</a> and inhibiting <a href="/wiki/Osteoprotegerin" title="Osteoprotegerin">osteoprotegerin</a> which activates <a href="/wiki/Nuclear_factor_kappa_B" class="mw-redirect" title="Nuclear factor kappa B">nuclear factor kappa B</a>, which causes further activation of osteoclast activity.<sup id="cite_ref-Guise_2022_22-2" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The combination of PTHrP driven osteoclast activation and calcium reabsorption by the kidneys causes hypercalcemia associated with malignancy (humoral type).<sup id="cite_ref-Guise_2022_22-3" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>Another mechanism in which cancer causes hypercalcemia is via local osteolysis due to <a href="/wiki/Metastasis" title="Metastasis">metastasis</a> to bone.<sup id="cite_ref-Guise_2022_22-4" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Tumor bone metastasis releases local cytokines including <a href="/wiki/Interleukin-6" class="mw-redirect" title="Interleukin-6">IL-6</a>, <a href="/wiki/Interleukin-8" class="mw-redirect" title="Interleukin-8">IL-8</a>, <a href="/wiki/Interleukin-11" class="mw-redirect" title="Interleukin-11">IL-11</a>, <a href="/wiki/Interleukin-1_beta" class="mw-redirect" title="Interleukin-1 beta">interleukin-1 beta</a>, <a href="/wiki/TNF_alpha" class="mw-redirect" title="TNF alpha">TNF alpha</a> and <a href="/wiki/Macrophage_inflammatory_protein" title="Macrophage inflammatory protein">macrophage inflammatory protein</a>. These cytokines activate osteoclasts and inhibit <a href="/wiki/Osteoblasts" class="mw-redirect" title="Osteoblasts">osteoblasts</a> (the cell type responsible for laying down new bone) via the <a href="/wiki/Rank_ligand" class="mw-redirect" title="Rank ligand">rank ligand</a> pathway leading to bone resorption and calcium release into the bloodstream.<sup id="cite_ref-Guise_2022_22-5" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The massive release of calcium from bone metastasis and osteoclast activation usually overwhelms the kidney's ability to secrete calcium, thus leading to hypercalcemia.<sup id="cite_ref-Guise_2022_22-6" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>Hypercalcemia of malignancy may also occur due to tumor production of <a href="/wiki/Vitamin_D" title="Vitamin D">vitamin D</a> or <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">parathyroid hormone</a>. These causes are rare and constitute about 1% of all causes of hypercalcemia of malignancy.<sup id="cite_ref-Guise_2022_22-7" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>Hypercalcemia of malignancy usually portends a poor prognosis, and the medial survival is 25–52 days of its development.<sup id="cite_ref-Guise_2022_22-8" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> It has an incidence of 30% in those with cancer, and the prevalence is estimated to be about 2-3% in the United States.<sup id="cite_ref-Guise_2022_22-9" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/54/Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg/220px-Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/54/Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg/330px-Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/54/Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg/440px-Small_cell_carcinoma_of_the_ovary_hypercalcemic_type_-_high_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a><figcaption><a href="/wiki/Micrograph" title="Micrograph">Micrograph</a> of ovarian small cell carcinoma of the hypercalcemic type. <a href="/wiki/H%26E_stain" title="H&E stain">H&E stain</a>.</figcaption></figure> <p>Common cancer types that are associated with hypercalcemia of malignancy include: </p> <ul><li>Solid tumor with metastasis via local osteolytic hypercalcemia: which can be due to any tumor that metastasizes to the bone. But common causes include <a href="/wiki/Breast_cancer" title="Breast cancer">breast cancer</a>, <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a>, <a href="/wiki/Kidney_cancer" title="Kidney cancer">kidney cancer</a>, and <a href="/wiki/Myeloma" class="mw-redirect" title="Myeloma">myeloma</a> or <a href="/wiki/Lymphoma" title="Lymphoma">lymphoma</a> of the bone<sup id="cite_ref-Guise_2022_22-10" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li>Solid tumor with humoral mediation of hypercalcemia: <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a> (especially squamous cell tumors, a type of <a href="/wiki/Non-small_cell_lung_cancer" class="mw-redirect" title="Non-small cell lung cancer">non-small cell lung cancer</a>), <a href="/wiki/Squamous_cell_cancer" class="mw-redirect" title="Squamous cell cancer">squamous cell cancers</a> of the head and neck, <a href="/wiki/Renal_cell_carcinoma" title="Renal cell carcinoma">kidney cancer</a> or other <a href="/wiki/Urothelial_cancer" class="mw-redirect" title="Urothelial cancer">urothelial cancers</a>, and breast cancer.<sup id="cite_ref-Guise_2022_22-11" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Hematology" title="Hematology">Hematologic</a> <a href="/wiki/Malignancy" title="Malignancy">cancers</a>: including <a href="/wiki/Multiple_myeloma" title="Multiple myeloma">multiple myeloma</a>, <a href="/wiki/Lymphoma" title="Lymphoma">lymphoma</a>, <a href="/wiki/Leukemia" title="Leukemia">leukemia</a></li> <li>Ovarian small cell carcinoma of the hypercalcemic type</li></ul> <div class="mw-heading mw-heading3"><h3 id="Vitamin-D_disorders">Vitamin-D disorders</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=6" title="Edit section: Vitamin-D disorders"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Hypervitaminosis_D" class="mw-redirect" title="Hypervitaminosis D">Hypervitaminosis D</a> (vitamin D intoxication)</li> <li>Elevated <a href="/wiki/1,25(OH)2D" class="mw-redirect" title="1,25(OH)2D">1,25(OH)<sub>2</sub>D</a> (see calcitriol under <a href="/wiki/Vitamin_D" title="Vitamin D">Vitamin D</a>) levels (e.g., <a href="/wiki/Sarcoidosis" title="Sarcoidosis">sarcoidosis</a> and other granulomatous diseases such as <a href="/wiki/Tuberculosis" title="Tuberculosis">tuberculosis</a>, <a href="/wiki/Berylliosis" title="Berylliosis">berylliosis</a>, <a href="/wiki/Histoplasmosis" title="Histoplasmosis">histoplasmosis</a>, <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>, and <a href="/wiki/Granulomatosis_with_polyangiitis" title="Granulomatosis with polyangiitis">granulomatosis with polyangiitis</a>)</li> <li><a href="/w/index.php?title=Idiopathic_hypercalcaemia_of_infancy&action=edit&redlink=1" class="new" title="Idiopathic hypercalcaemia of infancy (page does not exist)">Idiopathic hypercalcaemia of infancy</a><sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup></li> <li>Rebound hypercalcaemia after <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="High_bone-turnover">High bone-turnover</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=7" title="Edit section: High bone-turnover"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroidism</a></li> <li><a href="/wiki/Multiple_myeloma" title="Multiple myeloma">Multiple myeloma</a></li> <li>Prolonged immobilization</li> <li><a href="/wiki/Paget%27s_disease_of_bone" title="Paget's disease of bone">Paget's disease</a></li> <li><a href="/wiki/Thiazide" title="Thiazide">Thiazide</a> use</li> <li><a href="/wiki/Vitamin_A" title="Vitamin A">Vitamin A</a> intoxication<sup id="cite_ref-Ranaghan_2018_15-1" class="reference"><a href="#cite_note-Ranaghan_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Kidney_failure">Kidney failure</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=8" title="Edit section: Kidney failure"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Tertiary_hyperparathyroidism" title="Tertiary hyperparathyroidism">Tertiary hyperparathyroidism</a></li> <li><a href="/wiki/Aluminium" title="Aluminium">Aluminium</a> intoxication</li> <li><a href="/wiki/Milk-alkali_syndrome" title="Milk-alkali syndrome">Milk-alkali syndrome</a><sup id="cite_ref-Ranaghan_2018_15-2" class="reference"><a href="#cite_note-Ranaghan_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Other">Other</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=9" title="Edit section: Other"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Acromegaly" title="Acromegaly">Acromegaly</a></li> <li><a href="/wiki/Adrenal_insufficiency" title="Adrenal insufficiency">Adrenal insufficiency</a></li> <li><a href="/wiki/Zollinger%E2%80%93Ellison_syndrome" title="Zollinger–Ellison syndrome">Zollinger–Ellison syndrome</a></li> <li><a href="/wiki/Williams_Syndrome" class="mw-redirect" title="Williams Syndrome">Williams Syndrome</a></li> <li>Excessive calcium consumption</li></ul> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=10" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diagnosis should generally include either a calculation of <a href="/wiki/Corrected_calcium" class="mw-redirect" title="Corrected calcium">corrected calcium</a> or direct measurement of <a href="/wiki/Ionized_calcium" class="mw-redirect" title="Ionized calcium">ionized calcium</a> level and be confirmed after a week.<sup id="cite_ref-BMJ2015_1-20" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> This is because either high or low serum <a href="/wiki/Albumin" title="Albumin">albumin</a> levels does not show the true levels of ionised calcium.<sup id="cite_ref-Ranaghan_2018_15-3" class="reference"><a href="#cite_note-Ranaghan_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> There is, however, controversy around the usefulness of corrected calcium as it may be no better than total calcium.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p><p>Once calcium is confirmed to be elevated, a detailed history taken from the subject, including review of medications, any vitamin supplementations, herbal preparations, and previous calcium values. Chronic elevation of calcium with absent or mild symptoms often points to primary hyperparathyroidism or <a href="/wiki/Familial_hypocalciuric_hypercalcemia" title="Familial hypocalciuric hypercalcemia">Familial hypocalciuric hypercalcemia</a>. For those who has underlying malignancy, the cancers may be sufficiently severe to show up in history and examination to point towards the diagnosis with little laboratory investigations.<sup id="cite_ref-Ranaghan_2018_15-4" class="reference"><a href="#cite_note-Ranaghan_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>If detailed history and examination does not narrow down the differential diagnoses, further laboratory investigations are performed. Intact PTH (iPTH, biologically active <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">parathyroid hormone</a> molecules) is measured with immunoradiometric or immunochemoluminescent assay. Elevated (or high-normal) iPTH with high urine calcium/creatinine ratio (more than 0.03) is suggestive of primary hyperparathyroidism, usually accompanied by low serum phosphate. High iPTH with low urine calcium/creatinine ratio is suggestive of familial hypocalciuric hypercalcemia. Low iPTH should be followed up with <a href="/wiki/Parathyroid_hormone-related_protein" title="Parathyroid hormone-related protein">Parathyroid hormone-related protein</a> (PTHrP) measurements (though not available in all labs). Elevated PTHrP is suggestive of malignancy. Normal PTHrP is suggestive of multiple myeloma, vitamin A excess, milk-alkali syndrome, thyrotoxicosis, and immobilisation. Elevated <a href="/wiki/Calcitriol" title="Calcitriol">Calcitriol</a> is suggestive of lymphoma, sarcoidosis, granulomatous disorders, and excessive calcitriol intake. Elevated <a href="/wiki/Calcifediol" title="Calcifediol">calcifediol</a> is suggestive of vitamin D or excessive calcifediol intake.<sup id="cite_ref-Ranaghan_2018_15-5" class="reference"><a href="#cite_note-Ranaghan_2018-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>The normal range is 2.1–2.6 <a href="/wiki/Mmol/L" class="mw-redirect" title="Mmol/L">mmol/L</a> (8.8–10.7 mg/dL, 4.3–5.2 <a href="/wiki/MEq/L" class="mw-redirect" title="MEq/L">mEq/L</a>), with levels greater than 2.6 mmol/L defined as hypercalcaemia.<sup id="cite_ref-BMJ2015_1-21" class="reference"><a href="#cite_note-BMJ2015-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-EU2010_2-9" class="reference"><a href="#cite_note-EU2010-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-SI2005_4-1" class="reference"><a href="#cite_note-SI2005-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Moderate hypercalcaemia is a level of 2.88–3.5 mmol/L (11.5–14 mg/dL) while severe hypercalcaemia is > 3.5 mmol/L (>14 mg/dL).<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="ECG">ECG</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=11" title="Edit section: ECG"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Osborn_wave.gif" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Osborn_wave.gif/220px-Osborn_wave.gif" decoding="async" width="220" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Osborn_wave.gif/330px-Osborn_wave.gif 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Osborn_wave.gif/440px-Osborn_wave.gif 2x" data-file-width="478" data-file-height="478" /></a><figcaption>An Osborn wave, an abnormal EKG tracing that can be associated with hypercalcemia.</figcaption></figure> <p>Abnormal <a href="/wiki/Cardiac_arrhythmia" class="mw-redirect" title="Cardiac arrhythmia">heart rhythms</a> can also result, and <a href="/wiki/ECG" class="mw-redirect" title="ECG">ECG</a> findings of a short <a href="/wiki/QT_interval" title="QT interval">QT interval</a><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a>.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Hypercalcaemia has also been known to cause an <a href="/wiki/ECG" class="mw-redirect" title="ECG">ECG</a> finding mimicking hypothermia, known as an <a href="/wiki/Osborn_wave" class="mw-redirect" title="Osborn wave">Osborn wave</a>.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatments">Treatments</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=12" title="Edit section: Treatments"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The goal of therapy is to treat the hypercalcaemia first and subsequently effort is directed to treat the underlying cause. In those with a calcium level above 13 mg/dL, calcium level that is rising rapidly or those with altered mental status, urgent treatment is required.<sup id="cite_ref-Guise_2022_22-12" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Fluids_and_diuretics">Fluids and diuretics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=13" title="Edit section: Fluids and diuretics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Initial therapy:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <ul><li><ul><li><a href="/wiki/IV_fluids" class="mw-redirect" title="IV fluids">IV fluids</a> is the initial therapy.<sup id="cite_ref-Guise_2022_22-13" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Hypercalcemia usually causes symptoms that lead to chronic dehydration, such as nausea, vomiting, anorexia, and <a href="/wiki/Nephrogenic_diabetes_insipidus" title="Nephrogenic diabetes insipidus">nephrogenic diabetes insipidus</a> (inability of the kidney to concentrate the urine). IV fluid rehydration allows the kidneys to excrete more calcium, and usually lowers the calcium level by 1–2 mg/dL.<sup id="cite_ref-Guise_2022_22-14" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li>increased salt intake also can increase body fluid volume as well as increasing urine sodium excretion, which further increases urinary calcium excretion.</li> <li>after rehydration, a <a href="/wiki/Loop_diuretic" title="Loop diuretic">loop diuretic</a> such as <a href="/wiki/Furosemide" title="Furosemide">furosemide</a> can be given to permit continued large volume intravenous salt and water replacement while minimizing the risk of blood volume overload and <a href="/wiki/Pulmonary_edema" title="Pulmonary edema">pulmonary oedema</a>. In addition, <a href="/wiki/Loop_diuretics" class="mw-redirect" title="Loop diuretics">loop diuretics</a> tend to depress calcium reabsorption by the kidney thereby helping to lower blood calcium levels</li> <li>caution must be taken to prevent <a href="/wiki/Potassium#Supplementation" title="Potassium">potassium</a> or <a href="/wiki/Magnesium_deficiency_(medicine)" class="mw-redirect" title="Magnesium deficiency (medicine)">magnesium</a> depletion</li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Bisphosphonates_and_calcitonin">Bisphosphonates and calcitonin</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=14" title="Edit section: Bisphosphonates and calcitonin"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Additional therapy:<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <ul><li><a href="/wiki/Bisphosphonates" class="mw-redirect" title="Bisphosphonates">bisphosphonates</a> are <a href="/wiki/Pyrophosphate" title="Pyrophosphate">pyrophosphate</a> analogues with high affinity for bone, especially areas of high bone-turnover. <ul><li>they are taken up by <a href="/wiki/Osteoclast" title="Osteoclast">osteoclasts</a> and inhibit osteoclastic bone resorption, therefore inhibiting calcium release from osteoclasts</li> <li>current available drugs include: (1st generation) <a href="/wiki/Etidronate" class="mw-redirect" title="Etidronate">etidronate</a>, (2nd generation) <a href="/wiki/Tiludronate" class="mw-redirect" title="Tiludronate">tiludronate</a>, IV <a href="/wiki/Pamidronate" class="mw-redirect" title="Pamidronate">pamidronate</a>, <a href="/wiki/Alendronate" class="mw-redirect" title="Alendronate">alendronate</a> (3rd generation) <a href="/wiki/Zoledronate" class="mw-redirect" title="Zoledronate">zoledronate</a> and <a href="/wiki/Risedronate" class="mw-redirect" title="Risedronate">risedronate</a></li> <li>Bisphosphonates are used as a first line therapy for those with hypercalcemia of malignancy. They are used as both an acute therapy and are usually continued long term to prevent hypercalcemia.<sup id="cite_ref-Guise_2022_22-15" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li>Bisphosphonates are not recommended in those with <a href="/wiki/Chronic_kidney_disease" title="Chronic kidney disease">chronic kidney disease</a> or those who are severely dehydrated as they may worsen or cause kidney disease.<sup id="cite_ref-Guise_2022_22-16" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li>Bisphosphonates caused normalization of calcium levels in 60-90% of patients who were treated for hypercalcemia of malignancy.<sup id="cite_ref-Guise_2022_22-17" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li></ul></li> <li><a href="/wiki/Denosumab" title="Denosumab">Denosumab</a> is a bone anti-resorptive agent that can be used to treat hypercalcemia in patients with a <a href="/wiki/Contraindication" title="Contraindication">contraindication</a> to bisphosphonates such as severe kidney failure or allergy. <ul><li>Denosumab is a monoclonal antibody that inhibits osteoclasts. It acts by binding <a href="/wiki/RANK_ligand" class="mw-redirect" title="RANK ligand">RANK ligand</a> preventing it from activating osteoclasts via <a href="/wiki/NFKB" class="mw-redirect" title="NFKB">NFKB</a>.<sup id="cite_ref-Guise_2022_22-18" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li>Denosumab caused normalization of calcium levels in 70% in those with hypercalcemia of malignancy.<sup id="cite_ref-Guise_2022_22-19" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li></ul></li> <li><a href="/wiki/Calcitonin" title="Calcitonin">Calcitonin</a> blocks bone resorption by inhibiting osteoclasts and also increases urinary calcium excretion by the kidneys.<sup id="cite_ref-Guise_2022_22-20" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> <ul><li>Usually used in life-threatening hypercalcaemia along with rehydration, diuresis, and bisphosphonates</li> <li>Due to its limited duration of action (it works for 48–96 hours, then efficacy decreases as the calcitonin receptors are downregulated) its use is limited to acute hypercalcemia as a bridge therapy until more long-term treatments can be initiated.<sup id="cite_ref-Guise_2022_22-21" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Other_therapies">Other therapies</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=15" title="Edit section: Other therapies"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>rarely used, or used in special circumstances: <ul><li><a href="/wiki/Plicamycin" title="Plicamycin">plicamycin</a> inhibits bone resorption (rarely used)</li> <li><a href="/wiki/Gallium_nitrate" title="Gallium nitrate">gallium nitrate</a> inhibits bone resorption and changes structure of bone crystals (rarely used)</li> <li><a href="/wiki/Glucocorticoids" class="mw-redirect" title="Glucocorticoids">glucocorticoids</a> increase urinary calcium excretion and decrease intestinal calcium absorption <ul><li>no effect on calcium level in normal or primary hyperparathyroidism</li> <li>effective in hypercalcemia due to malignancy with elevated vitamin D levels (many types of malignancies raise the vitamin D level).<sup id="cite_ref-Guise_2022_22-22" class="reference"><a href="#cite_note-Guise_2022-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li>also effective in <a href="/wiki/Hypervitaminosis_D" class="mw-redirect" title="Hypervitaminosis D">hypervitaminosis D</a> and <a href="/wiki/Sarcoidosis" title="Sarcoidosis">sarcoidosis</a></li></ul></li> <li><a href="/wiki/Kidney_dialysis" title="Kidney dialysis">dialysis</a> usually used in severe hypercalcaemia complicated by <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>. Supplemental phosphate should be monitored and added if necessary</li> <li><a href="/wiki/Phosphate" title="Phosphate">phosphate</a> therapy can correct the hypophosphataemia in the face of hypercalcaemia and lower serum calcium, but this can further increase the risk for kidney stones and <a href="/wiki/Nephrocalcinosis" title="Nephrocalcinosis">nephrocalcinosis</a></li></ul></li></ul> <div class="mw-heading mw-heading2"><h2 id="Other_animals">Other animals</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=16" title="Edit section: Other animals"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Research has led to a better understanding of hypercalcemia in non-human animals. Often the causes of hypercalcemia have a correlation to the environment in which the organisms live. Hypercalcemia in house pets is typically due to disease, but other cases can be due to accidental ingestion of plants or chemicals in the home.<sup id="cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-0" class="reference"><a href="#cite_note-Hypercalcemia_in_Dogs_and_Cats-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Outdoor animals commonly develop hypercalcemia through <a href="/wiki/Hypervitaminosis_D" class="mw-redirect" title="Hypervitaminosis D">vitamin D toxicity</a> from wild plants within their environments.<sup id="cite_ref-Enzootic_Calcinosis_30-0" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Household_pets">Household pets</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=17" title="Edit section: Household pets"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Household pets such as dogs and cats are found to develop hypercalcemia. It is less common in cats, and many feline cases are <a href="/wiki/Idiopathic" class="mw-redirect" title="Idiopathic">idiopathic</a>.<sup id="cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-1" class="reference"><a href="#cite_note-Hypercalcemia_in_Dogs_and_Cats-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> In dogs, <a href="/wiki/Lymphosarcoma" class="mw-redirect" title="Lymphosarcoma">lymphosarcoma</a>, <a href="/wiki/Addison%27s_disease" title="Addison's disease">Addison's disease</a>, <a href="/wiki/Primary_hyperparathyroidism" title="Primary hyperparathyroidism">primary hyperparathyroidism</a>, and chronic <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a> are the main causes of hypercalcemia, but there are also environmental causes usually unique to indoor pets.<sup id="cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-2" class="reference"><a href="#cite_note-Hypercalcemia_in_Dogs_and_Cats-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Ingestion of small amounts of <a href="/wiki/Calcipotriol" title="Calcipotriol">calcipotriene</a> found in psoriasis cream can be fatal to a pet.<sup id="cite_ref-Topical_Agents_(Toxicity)_31-0" class="reference"><a href="#cite_note-Topical_Agents_(Toxicity)-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Calcipotriol" title="Calcipotriol">Calcipotriene</a> causes a rapid rise in calcium ion levels.<sup id="cite_ref-Topical_Agents_(Toxicity)_31-1" class="reference"><a href="#cite_note-Topical_Agents_(Toxicity)-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Calcium ion levels can remain high for weeks if untreated and lead to an array of medical issues.<sup id="cite_ref-Topical_Agents_(Toxicity)_31-2" class="reference"><a href="#cite_note-Topical_Agents_(Toxicity)-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> There are also cases of hypercalcemia reported due to dogs ingesting <a href="/wiki/Rodenticide" title="Rodenticide">rodenticides</a> containing a chemical similar to <a href="/wiki/Calcipotriol" title="Calcipotriol">calcipotriene</a> found in <a href="/wiki/Psoriasis" title="Psoriasis">psoriasis</a> cream.<sup id="cite_ref-Topical_Agents_(Toxicity)_31-3" class="reference"><a href="#cite_note-Topical_Agents_(Toxicity)-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Additionally, ingestion of household plants is a cause of hypercalcemia. Plants such as <i><a href="/wiki/Cestrum_diurnum" title="Cestrum diurnum">Cestrum diurnum</a></i>, and <i><a href="/wiki/Solanum_malacoxylon" class="mw-redirect" title="Solanum malacoxylon">Solanum malacoxylon</a></i> contain <a href="/wiki/Ergocalciferol" title="Ergocalciferol">ergocalciferol</a> or <a href="/wiki/Cholecalciferol" title="Cholecalciferol">cholecalciferol</a> which cause the onset of hypercalcemia.<sup id="cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-3" class="reference"><a href="#cite_note-Hypercalcemia_in_Dogs_and_Cats-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Consuming small amounts of these plants can be fatal to pets. Observable symptoms may develop such as <a href="/wiki/Polydipsia" title="Polydipsia">polydipsia</a>, <a href="/wiki/Polyuria" title="Polyuria">polyuria</a>, extreme fatigue, or constipation.<sup id="cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-4" class="reference"><a href="#cite_note-Hypercalcemia_in_Dogs_and_Cats-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Outdoor_animals">Outdoor animals</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=18" title="Edit section: Outdoor animals"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Trisetum.flavescens2.-.lindsey.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/Trisetum.flavescens2.-.lindsey.jpg/220px-Trisetum.flavescens2.-.lindsey.jpg" decoding="async" width="220" height="330" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/49/Trisetum.flavescens2.-.lindsey.jpg/330px-Trisetum.flavescens2.-.lindsey.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/4/49/Trisetum.flavescens2.-.lindsey.jpg 2x" data-file-width="400" data-file-height="600" /></a><figcaption><i><a href="/wiki/Trisetum_flavescens" title="Trisetum flavescens">Trisetum flavescens</a></i> (yellow oat grass)</figcaption></figure> <p>In certain outdoor environments, animals such as horses, pigs, cattle, and sheep experience hypercalcemia commonly. In southern <a href="/wiki/Brazil" title="Brazil">Brazil</a> and Mattewara <a href="/wiki/India" title="India">India</a>, approximately 17 per cent of sheep are affected, with 60 per cent of these cases being fatal.<sup id="cite_ref-Enzootic_Calcinosis_30-1" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Many cases are also documented in <a href="/wiki/Argentina" title="Argentina">Argentina</a>, <a href="/wiki/Papua_New_Guinea" title="Papua New Guinea">Papua New Guinea</a>, <a href="/wiki/Jamaica" title="Jamaica">Jamaica</a>, <a href="/wiki/Hawaii" title="Hawaii">Hawaii</a>, and <a href="/wiki/Bavaria" title="Bavaria">Bavaria</a>.<sup id="cite_ref-Enzootic_Calcinosis_30-2" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> These cases of hypercalcemeia are usually caused by ingesting <i><a href="/wiki/Trisetum_flavescens" title="Trisetum flavescens">Trisetum flavescens</a></i> before it has dried out.<sup id="cite_ref-Enzootic_Calcinosis_30-3" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Once <i>Trisetum flavescens</i> is dried out, the toxicity of it is diminished.<sup id="cite_ref-Enzootic_Calcinosis_30-4" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Other plants causing hypercalcemia are <i><a href="/wiki/Cestrum_diurnum" title="Cestrum diurnum">Cestrum diurnum</a></i>, <i><a href="/wiki/Nierembergia_veitchii" title="Nierembergia veitchii">Nierembergia veitchii</a></i>, <i><a href="/wiki/Solanum_esuriale" title="Solanum esuriale">Solanum esuriale</a></i>, <i><a href="/wiki/Solanum_torvum" title="Solanum torvum">Solanum torvum</a></i>, and <i><a href="/wiki/Solanum_malacoxylon" class="mw-redirect" title="Solanum malacoxylon">Solanum malacoxylon</a></i>.<sup id="cite_ref-Enzootic_Calcinosis_30-5" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> These plants contain <a href="/wiki/Calcitriol" title="Calcitriol">calcitriol</a> or similar substances that cause rises in calcium ion levels.<sup id="cite_ref-Enzootic_Calcinosis_30-6" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Hypercalcemia is most common in grazing lands at altitudes above 1500 meters where growth of plants like <i>Trisetum flavescens</i> is favorable.<sup id="cite_ref-Enzootic_Calcinosis_30-7" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Even if small amounts are ingested over long periods of time, the prolonged high levels of calcium ions have large negative effects on the animals.<sup id="cite_ref-Enzootic_Calcinosis_30-8" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> The issues these animals experience are muscle weakness, and <a href="/wiki/Calcification" title="Calcification">calcification</a> of blood vessels, heart valves, liver, kidneys, and other soft tissues, which eventually can lead to death.<sup id="cite_ref-Enzootic_Calcinosis_30-9" class="reference"><a href="#cite_note-Enzootic_Calcinosis-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=19" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Calcium_metabolism" title="Calcium metabolism">Calcium metabolism</a></li> <li><a href="/wiki/Dent%27s_disease" title="Dent's disease">Dent's disease</a></li> <li><a href="/wiki/Electrolyte_disturbance" class="mw-redirect" title="Electrolyte disturbance">Electrolyte disturbance</a></li> <li><a href="/wiki/Disorders_of_calcium_metabolism" title="Disorders of calcium metabolism">Disorders of calcium metabolism</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=20" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-BMJ2015-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-BMJ2015_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-15"><sup><i><b>p</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-16"><sup><i><b>q</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-17"><sup><i><b>r</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-18"><sup><i><b>s</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-19"><sup><i><b>t</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-20"><sup><i><b>u</b></i></sup></a> <a href="#cite_ref-BMJ2015_1-21"><sup><i><b>v</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFMinisolaPepePiemonteCipriani2015" class="citation journal cs1">Minisola S, Pepe J, Piemonte S, Cipriani C (2015). 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(June 2018)">page needed</span></a></i>]</sup></span> </li> <li id="cite_note-isbn0-07-147247-9-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-isbn0-07-147247-9_13-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTierney,_Lawrence_M.McPhee,_Stephen_J.Papadakis,_Maxine_A.2006" class="citation book cs1">Tierney, Lawrence M., McPhee, Stephen J., Papadakis, Maxine A. (2006). <a rel="nofollow" class="external text" href="https://archive.org/details/currentmedicaldi0046unse/page/901"><i>Current Medical Diagnosis and Treatment 2007 (Current Medical Diagnosis and Treatment)</i></a>. 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rel="nofollow" class="external text" href="https://web.archive.org/web/20100228072652/http://www.cancernetwork.com/cancer-management-11/chapter05/article/10165/1402668">Archived</a> 2010-02-28 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) <a rel="nofollow" class="external text" href="http://www.cancernetwork.com/cancer-management-11/">Cancer Management: A Multidisciplinary Approach</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20131004224102/http://www.cancernetwork.com/cancer-management-11/">Archived</a> 2013-10-04 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a>. 11 ed. 2008.</span> </li> <li id="cite_note-17"><span class="mw-cite-backlink"><b><a href="#cite_ref-17">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a 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title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Medicine&rft.atitle=Severe+hypercalcaemia+mimicking+acute+myocardial+infarction&rft.volume=9&rft.issue=2&rft.pages=186-7&rft.date=2009&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4952678%23id-name%3DPMC&rft_id=info%3Apmid%2F19435131&rft_id=info%3Adoi%2F10.7861%2Fclinmedicine.9-2-186&rft.aulast=Wesson&rft.aufirst=L&rft.au=Suresh%2C+V&rft.au=Parry%2C+R&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4952678&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypercalcaemia" class="Z3988"></span></span> </li> <li id="cite_note-28"><span class="mw-cite-backlink"><b><a href="#cite_ref-28">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSerafiVliekTaremi2012" class="citation journal cs1">Serafi SW, Vliek C, Taremi M (2012). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714046">"Osborn waves in a hypothermic patient"</a>. <i>Journal of Community Hospital Internal Medicine Perspectives</i>. <b>1</b> (4): 10742. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.3402%2Fjchimp.v1i4.10742">10.3402/jchimp.v1i4.10742</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714046">3714046</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23882340">23882340</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Community+Hospital+Internal+Medicine+Perspectives&rft.atitle=Osborn+waves+in+a+hypothermic+patient&rft.volume=1&rft.issue=4&rft.pages=10742&rft.date=2012&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3714046%23id-name%3DPMC&rft_id=info%3Apmid%2F23882340&rft_id=info%3Adoi%2F10.3402%2Fjchimp.v1i4.10742&rft.aulast=Serafi&rft.aufirst=Sami+W&rft.au=Vliek%2C+Crystal&rft.au=Taremi%2C+Mahnaz&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3714046&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypercalcaemia" class="Z3988"></span></span> </li> <li id="cite_note-Hypercalcemia_in_Dogs_and_Cats-29"><span class="mw-cite-backlink">^ <a href="#cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Hypercalcemia_in_Dogs_and_Cats_29-4"><sup><i><b>e</b></i></sup></a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.merckmanuals.com/vet/endocrine_system/the_parathyroid_glands_and_disorders_of_calcium_metabolism/hypercalcemia_in_dogs_and_cats.html">Hypercalcemia in Dogs and Cats</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20140728125538/http://www.merckmanuals.com/vet/endocrine_system/the_parathyroid_glands_and_disorders_of_calcium_metabolism/hypercalcemia_in_dogs_and_cats.html">Archived</a> 2014-07-28 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> Peterson DVM, DACVIM. M. E., July 2013. Hypercalcemia in Dogs and Cats. The Merck Veterinary Manual. Merck Sharp & Dohme, Whitehouse Station, NJ, USA.</span> </li> <li id="cite_note-Enzootic_Calcinosis-30"><span class="mw-cite-backlink">^ <a href="#cite_ref-Enzootic_Calcinosis_30-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-Enzootic_Calcinosis_30-9"><sup><i><b>j</b></i></sup></a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.merckmanuals.com/vet/musculoskeletal_system/dystrophies_associated_with_calcium_phosphorus_and_vitamin_d/enzootic_calcinosis.html">Enzootic Calcinosis</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20140728125957/http://www.merckmanuals.com/vet/musculoskeletal_system/dystrophies_associated_with_calcium_phosphorus_and_vitamin_d/enzootic_calcinosis.html">Archived</a> 2014-07-28 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> Gruenberg MS, PhD, DECAR DECBHM. W.G., April 2014. Enzootic Calcinosis. The Merck Veterinary Manual. Merck Sharp & Dohme, Whitehouse Station, NJ, USA.</span> </li> <li id="cite_note-Topical_Agents_(Toxicity)-31"><span class="mw-cite-backlink">^ <a href="#cite_ref-Topical_Agents_(Toxicity)_31-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Topical_Agents_(Toxicity)_31-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Topical_Agents_(Toxicity)_31-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Topical_Agents_(Toxicity)_31-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://www.merckmanuals.com/vet/toxicology/toxicities_from_human_drugs/topical_agents_toxicity.html">Topical Agents (Toxicity)</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20140728125702/http://www.merckmanuals.com/vet/toxicology/toxicities_from_human_drugs/topical_agents_toxicity.html">Archived</a> 2014-07-28 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a> Khan DVM, MS, PhD, DABVT, S.A., March 2012. Topical Agents (Toxicity). The Merck Veterinary Manual. Merck Sharp & Dohme, Whitehouse Station, NJ, USA.</span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hypercalcaemia&action=edit&section=21" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 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("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q1474877" class="extiw" title="d:Q1474877">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/E83.5">E83.5</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=275.42">275.42</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D006934">D006934</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb6196.htm">6196</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/66931009">66931009</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000365.htm">000365</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/1068-overview">med/1068</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/emerg/topic260.htm#">emerg/260</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/ped/topic1062.htm#">ped/1062</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/hypercalcaemia">Hypercalcaemia</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Electrolyte_imbalances" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Electrolyte_abnormalities" title="Template:Electrolyte abnormalities"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Electrolyte_abnormalities" title="Template talk:Electrolyte abnormalities"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Electrolyte_abnormalities" title="Special:EditPage/Template:Electrolyte abnormalities"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Electrolyte_imbalances" style="font-size:114%;margin:0 4em"><a href="/wiki/Electrolyte_imbalance" title="Electrolyte imbalance">Electrolyte imbalances</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Calcium_in_biology#Measurement" title="Calcium in biology">Calcium</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">High</a></li> <li><a href="/wiki/Hypocalcaemia" class="mw-redirect" title="Hypocalcaemia">Low</a></li> <li>Symptoms and signs <ul><li><a href="/wiki/Chvostek_sign" title="Chvostek sign">Chvostek sign</a></li> <li><a href="/wiki/Trousseau_sign_of_latent_tetany" title="Trousseau sign of latent tetany">Trousseau sign</a></li></ul></li> <li><a href="/wiki/Milk-alkali_syndrome" title="Milk-alkali syndrome">Milk-alkali syndrome</a></li> <li><a href="/wiki/Disorders_of_calcium_metabolism" title="Disorders of calcium metabolism">Disorders of calcium metabolism</a> <ul><li><a href="/w/index.php?title=Hypercalcemia_of_malignancy&action=edit&redlink=1" class="new" title="Hypercalcemia of malignancy (page does not exist)">Hypercalcemia of malignancy</a></li></ul></li> <li><a href="/wiki/Calcinosis" title="Calcinosis">Calcinosis</a> (<a href="/wiki/Calciphylaxis" title="Calciphylaxis">Calciphylaxis</a>, <a href="/wiki/Calcinosis_cutis" title="Calcinosis cutis">Calcinosis cutis</a>)</li> <li><a href="/wiki/Calcification" title="Calcification">Calcification</a> (<a href="/wiki/Metastatic_calcification" title="Metastatic calcification">Metastatic calcification</a>, <a href="/wiki/Dystrophic_calcification" title="Dystrophic calcification">Dystrophic calcification</a>)</li> <li><a href="/wiki/Familial_hypocalciuric_hypercalcemia" title="Familial hypocalciuric hypercalcemia">Familial hypocalciuric hypercalcemia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Serum_chloride" title="Serum chloride">Chloride</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hyperchloremia" title="Hyperchloremia">High</a></li> <li><a href="/wiki/Hypochloremia" title="Hypochloremia">Low</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Magnesium_in_biology" title="Magnesium in biology">Magnesium</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypermagnesemia" title="Hypermagnesemia">High</a></li> <li><a href="/wiki/Hypomagnesemia" class="mw-redirect" title="Hypomagnesemia">Low</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Phosphate_metabolism" class="mw-redirect" title="Phosphate metabolism">Phosphate</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hyperphosphatemia" title="Hyperphosphatemia">High</a></li> <li><a href="/wiki/Hypophosphatemia" title="Hypophosphatemia">Low</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Potassium" title="Potassium">Potassium</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hyperkalemia" title="Hyperkalemia">High</a> <ul><li><a href="/wiki/Hyperkalemic_periodic_paralysis" title="Hyperkalemic periodic paralysis">Hyperkalemic periodic paralysis</a> <ul><li><a href="/wiki/Hyperkalemic_periodic_paralysis_(equine)" title="Hyperkalemic periodic paralysis (equine)">equine</a></li></ul></li></ul></li> <li><a href="/wiki/Hypokalemia" title="Hypokalemia">Low</a> <ul><li><a href="/wiki/Hypokalemic_periodic_paralysis" title="Hypokalemic periodic paralysis">Hypokalemic periodic paralysis</a></li> <li><a href="/wiki/Hypokalemic_sensory_overstimulation" title="Hypokalemic sensory overstimulation">Hypokalemic sensory overstimulation</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sodium" title="Sodium">Sodium</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypernatremia" title="Hypernatremia">High</a> <ul><li><a href="/wiki/Salt_poisoning" title="Salt poisoning">Salt poisoning</a></li></ul></li> <li><a href="/wiki/Hyponatremia" title="Hyponatremia">Low</a> <ul><li><a href="/wiki/Hypotonic_hyponatremia" title="Hypotonic hyponatremia">Hypotonic</a></li> <li><a href="/wiki/Isotonic_hyponatremia" title="Isotonic hyponatremia">Isotonic</a></li> <li><a href="/wiki/Cerebral_salt-wasting_syndrome" title="Cerebral salt-wasting syndrome">Cerebral salt-wasting syndrome</a></li></ul></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Metal_deficiency_and_toxicity_disorders" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Metal_deficiency_and_toxicity_disorders" title="Template:Metal deficiency and toxicity disorders"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Metal_deficiency_and_toxicity_disorders" title="Template talk:Metal deficiency and toxicity disorders"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Metal_deficiency_and_toxicity_disorders" title="Special:EditPage/Template:Metal deficiency and toxicity disorders"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Metal_deficiency_and_toxicity_disorders" style="font-size:114%;margin:0 4em">Metal deficiency and toxicity disorders</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Iron_metabolism_disorder" title="Iron metabolism disorder">Iron</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i>excess:</i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Iron_overload" title="Iron overload">Iron overload</a></li> <li><a href="/wiki/Hemochromatosis" class="mw-redirect" title="Hemochromatosis">Hemochromatosis</a> <ul><li><a href="/wiki/HFE_hereditary_haemochromatosis" class="mw-redirect" title="HFE hereditary haemochromatosis">Hemochromatosis/HFE1</a></li> <li><a href="/wiki/Juvenile_hemochromatosis" title="Juvenile hemochromatosis">Juvenile/HFE2</a></li> <li><a href="/wiki/Haemochromatosis_type_3" title="Haemochromatosis type 3">HFE3</a></li> <li><a href="/wiki/African_iron_overload" title="African iron overload">African iron overload/HFE4</a></li></ul></li> <li><a href="/wiki/Aceruloplasminemia" title="Aceruloplasminemia">Aceruloplasminemia</a></li> <li><a href="/wiki/Atransferrinemia" title="Atransferrinemia">Atransferrinemia</a></li> <li><a href="/wiki/Hemosiderosis" title="Hemosiderosis">Hemosiderosis</a></li> <li><a href="/wiki/Neurodegeneration_with_brain_iron_accumulation" title="Neurodegeneration with brain iron accumulation">Neurodegeneration with brain iron accumulation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i>deficiency:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Iron_deficiency" title="Iron deficiency">Iron deficiency</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Copper_metabolism" class="mw-redirect" title="Copper metabolism">Copper</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i>excess:</i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Copper_toxicity" title="Copper toxicity">Copper toxicity</a></li> <li><a href="/wiki/Wilson%27s_disease" title="Wilson's disease">Wilson's disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i>deficiency:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Copper_deficiency" title="Copper deficiency">Copper deficiency</a></li> <li><a href="/wiki/Menkes_disease" title="Menkes disease">Menkes disease</a>/<a href="/wiki/Occipital_horn_syndrome" title="Occipital horn syndrome">Occipital horn syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Zinc_metabolism" class="mw-redirect" title="Zinc metabolism">Zinc</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i>excess:</i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Zinc_toxicity" title="Zinc toxicity">Zinc toxicity</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><span class="nobold"><i>deficiency:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acrodermatitis_enteropathica" title="Acrodermatitis enteropathica">Acrodermatitis enteropathica</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Inborn_errors_of_metabolism" title="Inborn errors of metabolism">Inborn errors of metabolism</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Paraneoplastic_syndromes" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Paraneoplastic_syndromes" title="Template:Paraneoplastic syndromes"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Paraneoplastic_syndromes" title="Template talk:Paraneoplastic syndromes"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Paraneoplastic_syndromes" title="Special:EditPage/Template:Paraneoplastic syndromes"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Paraneoplastic_syndromes" style="font-size:114%;margin:0 4em"><a href="/wiki/Paraneoplastic_syndrome" title="Paraneoplastic syndrome">Paraneoplastic syndromes</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endocrine_system" title="Endocrine system">Endocrine</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Hypercalcaemia</a></li> <li><a href="/wiki/Syndrome_of_inappropriate_antidiuretic_hormone_secretion" title="Syndrome of inappropriate antidiuretic hormone secretion">SIADH</a></li> <li><a href="/wiki/Zollinger%E2%80%93Ellison_syndrome" title="Zollinger–Ellison syndrome">Zollinger–Ellison syndrome</a></li> <li><a href="/wiki/Cushing%27s_syndrome" title="Cushing's syndrome">Cushing's syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Haematopoetic_system" class="mw-redirect" title="Haematopoetic system">Hematological</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Multicentric_reticulohistiocytosis" title="Multicentric reticulohistiocytosis">Multicentric reticulohistiocytosis</a></li> <li><a href="/wiki/Nonbacterial_thrombotic_endocarditis" title="Nonbacterial thrombotic endocarditis">Nonbacterial thrombotic endocarditis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurology" title="Neurology">Neurological</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Paraneoplastic_cerebellar_degeneration" title="Paraneoplastic cerebellar degeneration">Paraneoplastic cerebellar degeneration</a></li> <li><a href="/wiki/Encephalomyelitis" title="Encephalomyelitis">Encephalomyelitis</a></li> <li><a href="/wiki/Limbic_encephalitis" title="Limbic encephalitis">Limbic encephalitis</a></li> <li><a href="/wiki/Opsoclonus" title="Opsoclonus">Opsoclonus</a></li> <li><a href="/wiki/Polymyositis" title="Polymyositis">Polymyositis</a></li> <li><a href="/wiki/Transverse_myelitis" title="Transverse myelitis">Transverse myelitis</a></li> <li><a href="/wiki/Lambert%E2%80%93Eaton_myasthenic_syndrome" title="Lambert–Eaton myasthenic syndrome">Lambert–Eaton myasthenic syndrome</a></li> <li><a href="/wiki/Anti-NMDA_receptor_encephalitis" title="Anti-NMDA receptor encephalitis">Anti-NMDA receptor encephalitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_musculoskeletal_system" title="Human musculoskeletal system">Musculoskeletal</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dermatomyositis" title="Dermatomyositis">Dermatomyositis</a></li> <li><a href="/wiki/Hypertrophic_osteopathy" title="Hypertrophic osteopathy">Hypertrophic osteopathy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mucocutaneous_zone" class="mw-redirect" title="Mucocutaneous zone">Mucocutaneous</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Reactive <a href="/wiki/Erythema" title="Erythema">erythema</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Erythema_gyratum_repens" title="Erythema gyratum repens">Erythema gyratum repens</a></li> <li><a href="/wiki/Necrolytic_migratory_erythema" title="Necrolytic migratory erythema">Necrolytic migratory erythema</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Papulosquamous_disorder" title="Papulosquamous disorder">Papulosquamous</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acanthosis_nigricans" title="Acanthosis nigricans">Acanthosis nigricans</a></li> <li><a href="/wiki/Ichthyosis_acquisita" title="Ichthyosis acquisita">Ichthyosis acquisita</a></li> <li><a href="/wiki/Acrokeratosis_paraneoplastica_of_Bazex" class="mw-redirect" title="Acrokeratosis paraneoplastica of Bazex">Acrokeratosis paraneoplastica of Bazex</a></li> <li><a href="/wiki/Extramammary_Paget%27s_disease" title="Extramammary Paget's disease">Extramammary Paget's disease</a></li> <li><a href="/wiki/Florid_cutaneous_papillomatosis" title="Florid cutaneous papillomatosis">Florid cutaneous papillomatosis</a></li> <li><a href="/wiki/Leser%E2%80%93Tr%C3%A9lat_sign" title="Leser–Trélat sign">Leser-Trélat sign</a></li> <li><a href="/wiki/Pityriasis_rotunda" title="Pityriasis rotunda">Pityriasis rotunda</a></li> <li><a href="/wiki/Tripe_palms" title="Tripe palms">Tripe palms</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Febrile_neutrophilic_dermatosis" title="Febrile neutrophilic dermatosis">Febrile neutrophilic dermatosis</a></li> <li><a href="/wiki/Pyoderma_gangrenosum" title="Pyoderma gangrenosum">Pyoderma gangrenosum</a></li> <li><a href="/wiki/Paraneoplastic_pemphigus" title="Paraneoplastic pemphigus">Paraneoplastic pemphigus</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" 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srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><ul><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Hyperkalzämie"><a rel="nofollow" class="external text" href="https://d-nb.info/gnd/4239846-0">Germany</a></span></span></li><li><span class="uid"><a rel="nofollow" class="external text" href="https://id.loc.gov/authorities/sh85063679">United States</a></span></li><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Hypercalcémie"><a rel="nofollow" class="external text" href="https://catalogue.bnf.fr/ark:/12148/cb124507394">France</a></span></span></li><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Hypercalcémie"><a rel="nofollow" class="external text" href="https://data.bnf.fr/ark:/12148/cb124507394">BnF data</a></span></span></li><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="hyperkalcémie"><a rel="nofollow" class="external text" href="https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph194790&CON_LNG=ENG">Czech Republic</a></span></span></li><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Hipercalcemia"><a rel="nofollow" class="external text" href="http://catalogo.bne.es/uhtbin/authoritybrowse.cgi?action=display&authority_id=XX550225">Spain</a></span></span></li><li><span class="uid"><a rel="nofollow" class="external text" href="https://kopkatalogs.lv/F?func=direct&local_base=lnc10&doc_number=000338118&P_CON_LNG=ENG">Latvia</a></span></li><li><span class="uid"><a rel="nofollow" class="external text" href="http://olduli.nli.org.il/F/?func=find-b&local_base=NLX10&find_code=UID&request=987007536183505171">Israel</a></span></li></ul></div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=Hypercalcaemia&oldid=1257549241">https://en.wikipedia.org/w/index.php?title=Hypercalcaemia&oldid=1257549241</a>"</div></div> <div id="catlinks" class="catlinks" data-mw="interface"><div id="mw-normal-catlinks" class="mw-normal-catlinks"><a href="/wiki/Help:Category" title="Help:Category">Categories</a>: <ul><li><a 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