The short answer:
To reduce too much calcium in your blood, you have to keep hydrated, check your medications to avoid those that could induce hypercalcemia, control your vitamin D blood level, avoid smoking, and avoid or reduce your calcium-rich diet. Read more about how to reduce calcium blood level in this article.
- The normal total calcium blood level is 2.2-2.6 mmol/L.
- Mild hypercalcemia means that your calcium level is between 2.63 and 3 mmol per L.
- A total calcium level over 3.753 mmol/L can be life-threatening
- To reduce too much calcium blood level:
- Avoid calcium-containing supplements
- Control daily calcium intake
- Check vitamin D blood levels
- Avoid medication that is associated with hypercalcemia
- Control your intake of food-rich foods
- Keep hydrated
- Regular exercise
- Avoid smoking
- Treatments of hypercalcemia include adequate hydration and pharmacological therapies such as bisphosphonate and calcitonin.
What level of calcium is too high?
Normal calcium blood levels:
- Normal ionized calcium is 1.12- 1.45 mmol/L (4.54-5.61 mg/dL).
- Normal total calcium is 2.2-2.6 mmol/L (9-10.5 mg/dl).
Low calcium blood level (Hypocalcemia)
- Total calcium of less than 8.0 mg/dL is known as hypocalcemia,
- Calcium blood level below 1.59 mmol/L (6 mg/dL) is generally fetal hypocalcemia.
High calcium blood level (Hypercalcemia)
- Hypercalcemia is considered mild if the total serum calcium level is between 10.5 and 12 mg per dL (2.63 and 3 mmol per L).
- Total calcium levels over 3.753 mmol/L (15.12 mg/dL) can be life-threatening (generally fetal).
There are two main causes of Hypercalcemia:
- Hyperparathyroidism-induced hypercalcemia, it means an increase in parathyroid hormones secretion
- Hypercalcemia caused by a tumor (malignancy-related hypercalcemia)
Hypercalcemia affects approximately 1% to 2% of the general population. About 90 % of cases are due to primary hyperparathyroidism and cancer-related hypercalcemia.
According to the National Institute of Health, the recommended daily allowance of calcium varies with age. The recommended daily dose for adults (male and female) is 1000 milligrams per day, however, for breastfeeding women and people with amenorrhea the dose might increase.
How to reduce calcium blood levels?
- Drinking plenty of water could help you to lower your calcium blood levels and avoid kidney stone formation.
- It is recommended to drink 1.8 to 2.4 Liter per day (six to eight glasses of water per day).
- The urine color is an indicator of dehydration, it should be light in color, if it becomes darker, it means you need to drink plenty of water
- It is advised to drink water regularly and don’t wait until you feel thirsty. Thirsty is an indication that you are going to be dehydrated.
- Smoking is one of the most common causes of cancer. Cancer is also among the most common causes of hypercalcemia. Thus, when you stop smoking you will get more benefits.
- Smoking increases bone loss, thus increasing the calcium in the blood.
- Regular exercise is important for healthy bones. Bone resorption contributes largely to your elevated blood calcium levels.
- Try to keep regular exercise, especially those associated with bone health and bone strength problems.
- Exercise for at least 30 minutes is recommended and you can increase if it is possible.
Avoid taking medications without counseling your doctors
- Certain medications are strongly associated with high calcium blood levels such as lithium, and antacid containing calcium. Vitamin A, and thiazide diuretics, so you have to take care about medications containing calcium
- Ask your doctors about antacids that don’t contain calcium. Bismuth subsalicylate antacid is the best choice in this case.
- In case you are a hypertensive patient and using thiazide diuretics, you have to ask your doctors about safe alternatives that do not affect calcium blood level.
- If you are taking multivitamins, you should avoid those containing calcium.
- You have to check the prescription of your medications to avoid those containing thiazide diuretics, calcium, lithium, and vitamin A
Avoid a calcium-rich diet after counseling your doctors
- You should ask your doctor first before changing your diet and decrease calcium-containing foods as calcium is an essential element for numerous body function.
- Calcium-rich diet includes leafy greens and calcium-fortified cereals.
Control Vitamin D supplements
- Increased vitamin D intake is significantly associated with a high blood calcium level.
- Vitamin D supplements in excess of 800 international units/day, increase your risk to develop a high calcium blood level (Ref).
Ask your doctors about measuring your calcium level in the blood and urine regularly.
- If you are at a high risk to develop hypercalcemia, it is better to check your calcium level regularly.
- A regular check of your calcium level could help you to control your calcium level easily.
Check vitamin D blood level
Hypercalcemia is strongly related to vitamin D blood levels.
If you are at risk of hypercalcemia, it is recommended to check your calcium blood level regularly.
Took to your doctor in case you have a family history of high calcium, kidney stones, or hyperparathyroidism.
Symptoms of hypercalcemia
Most common symptoms of hypercalcemia
- Bone pain
- Frequent urination
- Polydipsia (thirst sensation
- Muscle aches
Severe hypercalcemia may lead to serious health problems including the following :
- Cardiac arrhythmia
- Renal failure
How to treat hypercalcemia:
Treatments goals of hypercalcemia include
- Control the symptoms.
- Prevents the development of irreversible organ damage and death.
Treatments strategies for hypercalcemia include:
Firstly: adequate hydration
Secondary: Administration of medications that inhibit bone resorption
To promote calcium exertion by the kidneys via restoring the extracellular volume with intravenous infusion of saline. Isotonic saline 0.9 % for 24 to 48 hours could correct possible volume depletion-induced hypercalcemia.
Treatemnts of hypercalcemia via the administration of medications that inhibit bone resorption. This inculdes the following:
The first choice of treatment of hypercalcemia is the intravenous administration of bisphosphonates then continuing with oral therapy or repeating the intravenous bisphosphonates to avoid relapse (Ref).
unfortunately, these medications have a slow onset of action about 1-3 days. However, they show potent and sustainable effects on bone resorption that could last to 12-30 days.
Bisphosphonates act by interfering with the ability of osteoclasts to resorb bone, therefore, inhibiting calcium release.
There are two FDA-approved bisphosphonates which are pamidronate, and zoledronic acid.
Possible side effects of these medications include a transient flu-like illness and hypophosphatemia.
For severe hypercalcemia, Calcitonin is the drug of choice for its rapid response.
Calcitonin is best to be administered intramuscularly or subcutaneously for rapid response. It is best to be administered in conjugation with bisphosphonate to get the benefits of the rapid response of calcitonin and the potent effect of long-acting bisphosphonate.
It is most useful in symptomatic patients in case of calcium blood level higher than 14 mg/dL (3.5 mmol/L).
1. What fluid is best for hypercalcemia?
Intravenous infusion of normal saline (0.9%) is the best choice to treat hypercalcemia caused by dehydration.
Saline infusion of 3-6 liters over 24–48 hours can lower calcium levels by 1–3 mg/dL. However, careful monitoring is essential to avoid fluid overlapping (Ref).
2. How do you treat hypercalcemia in cancer patients?
In the case of hypercalcemia secondary to cancer (hypercalcemia due to malignancy). Certain therapeutics might be helpful to lower your calcium blood level (Ref).
- Bisphosphonates (pamidronate and zoledronic acid).
- Denosumab in case you don’t respond to Bisphosphonates (Ref).
- Severe cases may require hospitalization.
3. How do you treat hypercalcemia in patients with hyperparathyroidism?
In case of hypercalcemia due to hyperparathyroidism, your doctor probably recommends surgical removal of the overactive gland to lower calcium blood level.