Hypercalcaemia in palliative care

Hypercalcaemia can be an emergency which needs urgent medical attention. Help patients to get an early diagnosis and treatment by knowing who is at risk and what the signs and symptoms are.

On this page:

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 happens in 10-30% of people, 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. The healthcare team will give the patient a full assessment including a blood test, with their permission.

If a patient is receiving care for the last days of their life, it might not be appropriate to give treatment. Find out what their wishes are, 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 those close to them information about the symptoms of hypercalcaemia.
• Encourage patients 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.

Useful resources 

NICE Clinical Knowledge Summary   - Hypercalcaemia

Scottish Palliative Care Guidelines   - Hypercalcaemia

Let us know what you think

Email your feedback to knowledgezone@mariecurie.org.uk 

Disclaimer

This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals. 

The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.

Did you find this page useful?

Help us be there for anyone with an illness they're likely to die from by telling us what you think.

If you are completing this survey using a desktop computer, hold down the Ctrl button to select multiple options.