+ Mnemonic for symptoms Stones Kidney or biliary Bones Bone pain Groans Abdominal discomfort Moans Complaints of non-specific symptoms Thrones Constipation and excessive urination volume Muscle tone Muscle weakness, decreased reflexes Psychiatric overtones Depression, anxiety, cognitive dysfunction The neuromuscular symptoms of hypercalcaemia are caused by a negative bathmotropic effect due to the increased interaction of calcium with sodium channels. Since calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers, increased calcium raises the threshold for depolarization. This results in diminished deep tendon reflexes (hyporeflexia), and skeletal muscle weakness. Other symptoms include cardiac arrhythmias (especially in those taking digoxin), fatigue, nausea, vomiting (emesis), loss of appetite, abdominal pain, & paralytic ileus. If kidney impairment occurs as a result, manifestations can include increased urination, urination at night, and increased thirst. Psychiatric manifestation can include emotional instability, confusion, delirium, psychosis, and stupor. Calcium deposits known as limbus sign may be visible in the eyes. Symptoms are more common at high calcium blood values (12.0 mg/dl or 3 mmol/l). Severe hypercalcaemia (above 15–16 mg/dl or 3.75–4 mmol/l) is considered a medical emergency: at these levels, coma and cardiac arrest can result. The high levels of calcium ions decrease the neuron membrane permeability to sodium ions, thus decreasing excitability, which leads to hypotonicity of smooth and striated muscle. This explains the fatigue, muscle weakness, low tone and sluggish reflexes in muscle groups. The sluggish nerves also explain drowsiness, confusion, hallucinations, stupor or coma. In the gut this causes constipation. Hypocalcaemia causes the opposite by the same mechanism. Hypercalcaemic crisis A hypercalcaemic crisis is an emergency situation with a severe hypercalcaemia, generally above approximately 14 mg/dL (or 3.5 mmol/l). The main symptoms of a hypercalcaemic crisis are oliguria or anuria, as well as somnolence or coma. After recognition, primary<unk>  should be proved or excluded. In extreme cases of primary<unk> , removal of the parathyroid gland after surgical neck exploration is the only way to avoid death. The diagnostic program should be performed within hours, in parallel with measures to lower serum calcium. Treatment of choice for acutely lowering calcium is extensive hydration and calcitonin, as well as bisphosphonates (which have effect on calcium levels after one or two days).
medical diagnosis of Hyperparathyroidism
medical cause of Hyperparathyroidism
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symptom of Hyperparathyroidism
complications of Hyperparathyroidism
medical cause of Hypophosphatemia
medical cause of Hyperphosphatemia