Physical Examination

Hypercalcaemia has few physical examination findings specific to its diagnosis. Often it is the symptoms or signs of underlying malignancy that bring the patient with hypercalcaemia to seek medical attention.

The primary malignancy may be suggested by lung findings, skin changes, lymphadenopathy, or liver or spleen enlargement.

Hypercalcaemia can produce a number of non-specific findings, as follows:

• Hypertension and bradycardia may be noted in patients with hypercalcaemia
• Abdominal examination may suggest pancreatitis or the possibility of an ulcer
• Patients with long-standing elevation of serum calcium may have proximal muscle weakness that is more prominent in the lower extremities and may have bony tenderness to palpation
• Hyporeflexia and tongue fasciculations may be present
• Anorexia or nausea may occur
• Polyuria and dehydration are common
• Lethargy, stupor or even coma may be observed
• Long-standing hypercalcaemia may cause band keratopathy, but this is rarely recognised in the emergency department

If hypercalcaemia is as a result of sarcoidosis, vitamin D intoxication or hyperthyroidism, patients may have physical examination findings suggestive of those diseases.