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Hypercalcemia symptoms: What are the early signs of hypercalcemia?

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated Oct. 27, 2023  •  Published Jun. 5, 2023
Fact Checked
Hypercalcemia symptoms

Overview: What does hypercalcemia feel like?

Calcium is essential to bone health, heart function, blood clotting, and other vital bodily functions. However, too much calcium circulating in the blood, called hypercalcemia, is a potentially serious problem. Normally, 98% of the calcium in the body is locked up in the bones. The remaining 2% circulates in the blood, about eight to 10 milligrams per deciliter. Calcium levels are a problem when they exceed 10 mg/dL. When they go above 14 mg/dL, calcium levels are now a serious threat. 

Unfortunately, there are usually no early warning signs of mild hypercalcemia, but severe hypercalcemia will start to show symptoms throughout the body, which healthcare professionals have nicknamed groans (digestive system problems), bones (bone pain and other symptoms), stones (kidney stones), moans (feeling sick and fatigued), thrones (excessive urination and dehydration), and psychic overtones (problems thinking, memory problems, a depressed mood). The longer calcium levels stay high, the more likely a serious complications such as kidney stones, osteoporosis, and vision problems will occur.

Key takeaways:

  • Hypercalcemia is a common health condition that affects any age, sex, race, or ethnicity. 

  • There are usually no signs of mild hypercalcemia.

  • Serious symptoms of hypercalcemia, such as irregular heartbeats, require immediate medical attention.

  • The most common causes of hypercalcemia are overactive parathyroid glands or cancers such as lung cancer, breast cancer, lymphoma, and multiple myeloma (called hypercalcemia of malignancy). Other causes include kidney failure, lung diseases, hormone disorders, autoimmune disorders such as sarcoidosis, bone disorders such as Paget’s disease, inherited disorders such as familial hypocalciuric hypercalcemia (FHH), excessive calcium intake, excessive vitamin D intake, and side effects of certain prescription medications such as lithium. You may be at risk for developing hypercalcemia symptoms if you are female, older than 50, or have cancer or a family history of hypercalcemia.

  • Hypercalcemia requires a medical diagnosis.

  • Hypercalcemia usually requires treatment. Hypercalcemia symptoms typically resolve after treatment.

  • Treatment of hypercalcemia may include treating the underlying cause, switching medications, reducing calcium or vitamin D intake, or removing prescription drugs that may be the cause. 

  • Untreated hypercalcemia could result in osteoporosis, kidney stones, kidney failure, heart problems, pancreas swelling, stomach ulcers, arthritis, and eye problems.

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What are the early signs of hypercalcemia?

There are no early signs of mild hypercalcemia. Most cases of elevated calcium are discovered on routine blood tests. Sometimes hypercalcemia is an accidental discovery, but other times people will be given blood tests because they have a condition that puts them at risk for hypercalcemia such as cancer, hyperparathyroidism, or if they take certain medications.

Other hypercalcemia symptoms

Once calcium gets high enough to be diagnosed as a severe case of hypercalcemia, symptoms appear throughout the body. Sometimes symptoms appear when calcium levels are still in the moderate range. Healthcare professionals often call the symptoms of hypercalcemia groans, bones, moans, stones, thrones, and psychic overtones. 

The gastrointestinal symptoms (“groans”) of hypercalcemia include:

The skeletal symptoms of hypercalcemia (“bones”) include:

The “moans” symptoms of hypercalcemia include problems like:

  • Feeling sick

  • Tiredness and fatigue

Kidney symptoms (“stones” and “thrones”) include:

  • Kidney pain due to kidney stones

  • Excessive urination (“thrones”)

  • Dehydration

  • Excessive thirst

Nervous system (“psychic overtones”) and muscular symptoms of hypercalcemia include:

  • Lethargy

  • Depression

  • Irritability

  • Problems thinking

  • Memory problems

  • Confusion

  • Coma

  • Psychosis

  • Muscle weakness (severe hypercalcemia)

High calcium also affects the heart and can cause:

Other symptoms include:

  • Itching

  • Pink eye

  • Loss of vision due to calcium deposits on the cornea

Hypercalcemia vs. hypocalcemia symptoms

Hypercalcemia and hypocalcemia are polar opposite problems. While hypercalcemia involves high calcium levels in the blood, hypocalcemia occurs when there’s too little calcium in the blood. Because calcium is necessary for so many processes in the body, hypocalcemia affects many of the same parts of the body as hypercalcemia. The effects are often different, however. The classic sign of hypocalcemia is overexcited muscles: twitching, spasms, and even muscle rigidity in severe cases. Unlike hypercalcemia, low blood calcium can be a life-threatening problem requiring emergency medical treatment.

Hypercalcemia Hypocalcemia
Shared symptoms
  • Confusion
  • Memory loss
  • Irritability
  • Depression
  • Abnormal heart rhythms (arrhythmias)
Unique symptoms
  • Muscle weakness
  • Coma
  • Digestive system complaints
  • Bone pain and other problems 
  • Kidney pain
  • Frequent urination
  • Muscle twitching and spasms
  • Hallucinations
  • Seizures
  • TIngling

Stages of hypercalcemia: How can I tell which one I have?

Hypercalcemia is diagnosed based on blood calcium levels. The more calcium in the blood, the more problems and complications it can cause.

Mild hypercalcemia 

Mild hypercalcemia is diagnosed when serum calcium concentration is slightly higher than normal (10.5 to 11.9 mg/dL. There are typically no symptoms, so mild cases of high calcium are routinely discovered on a blood test.

Moderate hypercalcemia 

Moderate hypercalcemia is diagnosed when serum calcium is statistically much higher than normal (12 to 13.9 mg/dL). There may be no symptoms, but if there are, they tend to be mild such as digestive system complaints. 

Severe hypercalcemia 

Severe hypercalcemia, also called hypercalcemic crisis, occurs when calcium levels are between 14 and 16 mg/dL. Most symptoms of hypercalcemia, such as excessive urination, dehydration, muscle weakness, bone pain, problems with thinking and memory, and kidney stones, are signs that blood calcium is dangerously high. Even if there are no symptoms, immediate treatment is required.

When to see a doctor for hypercalcemia symptoms

If there’s any suspicion, talk to a healthcare provider about hypercalcemia symptoms, even if they’re mild. High blood calcium may be due to a more serious medical condition, so it’s important to have the cause looked into. Most hypercalcemia symptoms are signs of severe high serum calcium, so body-wide symptoms indicate that treatment is needed as soon as possible. 

High calcium is diagnosed with a blood test that measures calcium levels in the blood, both total calcium and ionized calcium. When hypercalcemia is diagnosed, other blood tests may be performed to identify an underlying cause or possible complications. PTH levels (parathyroid hormone levels), phosphate levels, electrolyte levels, kidney function, and vitamin D levels are often ordered.

A medical history may help identify an underlying cause, such as primary hyperparathyroidism, cancer, or medication side effects.

If high calcium is chronic or severe, additional tests will be used to assess the health of affected systems. An electrocardiogram (EKG) will spot heart rhythm irregularities. If the cause of high calcium levels is unknown, X-ray or CT may be used to look for bony metastasis from a cancer originating in a different organ. A mammogram may be used to diagnose a suspicious breast mass. DEXA scan may be used to spot loss of bone density. The 4 parathyroid glands, located in the neck near the thyroid) may be visualized at with a CT scan or ultrasound. 

Complications of hypercalcemia

Untreated hypercalcemia can lead to complications such as:

How to treat hypercalcemia symptoms

Mild and asymptomatic moderate hypercalcemia are typically not health-threatening conditions. However, if there are symptoms, high blood calcium requires immediate treatment to restore lower calcium levels. 

People with mild hypercalcemia or symptomless moderate hypercalcemia are typically advised to avoid anything that will increase their calcium. If they’re taking too much calcium, such as antacids, or too much vitamin D, cut back on calcium or vitamin D intake. If high calcium is caused by prescription medications like thiazide diuretics, switch to a medication that doesn’t affect calcium levels. 

Immediate and aggressive treatment is used for symptomatic hypercalcemia or if calcium levels are in the severe range. These treatments include:

  • IV fluids to increase blood volume and to excrete more calcium

  • Loop diuretics to eliminate more calcium in the urine

  • Bisphosphonates or calcitonin to decrease calcium absorption

  • Dialysis in the most serious and life-threatening cases

  • Surgical removal of one or more parathyroid glands if primary hyperparathyroidism is causing high calcium

Living with hypercalcemia 

People with milder cases of hypercalcemia are not admitted to the hospital.. Chronically high calcium levels do not usually pose a serious threat if there are no symptoms. Healthcare professionals advise a few precautions to avoid raising calcium levels further:

  • Drink plenty of fluids throughout the day

  • Do not take in more than 1000 mg of calcium per day (this includes through diet, vitamins, and supplements)

  • Avoid calcium supplements, multivitamins with calcium, and calcium-based antacids such as Tums or Rolaids

  • Avoid taking excessive amounts of vitamin D supplements

  • Be aware of the symptoms of high calcium and immediately contact a healthcare provider if they’re experienced

Most importantly, see a doctor if symptoms of hypercalcemia are experienced

The most extreme symptoms of hypercalcemia usually don’t occur until the calcium levels are damaging the body’s systems. See a doctor immediately if hypercalcemia symptoms are experienced, especially if there are changes in mental functioning, such as confusion, lethargy, memory loss, and similar problems. Healthcare providers need to quickly restore calcium levels to safer levels. Even if symptoms are mild, talk to a healthcare professional. High calcium may indicate a more serious medical condition, like a carcinoma or hormone problem.

FAQs about hypercalcemia symptoms

Does hypercalcemia cause anxiety?

Even mild cases of hypercalcemia can cause mood changes such as irritability and anxiety.

Can hypercalcemia cause mood swings?

Mood swings are not a symptom of high calcium, but mood changes are among the earliest symptoms of moderate and sometimes even mild hypercalcemia. Anxiety, depression, and irritability are the most common. 

Does hypercalcemia affect blood pressure?

Severe hypercalcemia increases blood pressure. Higher levels of calcium cause blood vessels to contract and narrow, raising blood pressure. Excess parathyroid hormone—one of the major causes of hypercalcemia—lowers blood pressure. So the two problems sometimes balance out. However, people with hypercalcemia due to other causes will experience more severe hypertension due to severely high blood calcium.

What’s next? Additional resources for people with hypercalcemia symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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