Hypercalcaemia can be an emergency needing urgent medical attention. Help patients get an early diagnosis and treatment by knowing who is at risk and what the signs and symptoms are.
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Key points
- Hypercalcaemia is an emergency that can happen in palliative care.
- The signs and symptoms of hypercalcaemia are common in palliative care.
- Know the signs and symptoms and get help immediately if you suspect it.
- Call the patient's GP or specialist nurse for help.
- Keep calm and explain what’s happening to the patient and people important to them.
What is hypercalcaemia?
Hypercalcaemia is a high level of calcium in the blood. It can be caused by changes to the bones in patients with cancer, even if the cancer has not spread to the bone.
Patients most at risk of hypercalcaemia
Hypercalcaemia is common in people with advanced cancer. It is thought that approximately 20 out of 100 (20%) of people with cancer may experience hypercalcaemia at some stage during their illness, depending on the type of cancer they have.
The cancers that most commonly cause hypercalcaemia include multiple myeloma, breast, lung and kidney. Other cancers that are linked with hypercalcaemia include head and neck, thyroid, oesophageal, skin, cervix and bladder.
Signs and symptoms of hypercalcaemia
The signs and symptoms of hypercalcaemia vary and can be caused by other cancer-related problems or treatment. If a patient's health gets worse for no clear reason, consider hypercalcaemia.
Hypercalcaemia can cause:
- weakness and fatigue
- feeling generally unwell
- loss of appetite
- nausea and vomiting
- bone pain
- feeling thirsty and drinking a lot
- passing a lot of urine
- constipation
- confusion
- drowsiness
- seizures
- delirium.
If you suspect hypercalcaemia
Tell the patient's GP, district nurse or palliative care team immediately if you think they might have hypercalcaemia. With their permission, the healthcare team will give the patient a full assessment including a blood test.
If a patient is receiving care for the last days of their life, it might not be appropriate to give treatment. Find out their wishes and check their advance care plan, if they have one.
The patient will need to go to hospital or a hospice if treatment is appropriate. They may have intravenous (IV) fluids and bisphosphonate treatment (medicine that strengthens bones and prevents them getting weaker).
Supporting patients with hypercalcaemia
Once a patient has been diagnosed with hypercalcaemia, there are some things you can do to help them:
- Give the patient and the people important to them information about the symptoms of hypercalcaemia.
- Encourage them to report any symptoms of hypercalcaemia to someone from their healthcare team. This is because they're at high risk of getting hypercalcaemia again soon after treatment.
- Encourage them to drink fluids. If they have heart or kidney disease, make sure you know what fluid intake is appropriate for them.
- Help them to keep moving if they're able to.
- Speak to the GP or specialist nurse about stopping calcium supplements and any drugs that can worsen hypercalcaemia.
- Be aware of possible side effects of bisphosphonate treatment, such as mild flu-like symptoms and jaw problems.