Clinical Features

• Nephrolithiasis, nephrocalcinosis (calcium oxalate > calcium phosphate stones)

• Bone pain, arthralgias, myalgias, fractures

• Constipation

• Abdominal pain

• Nausea and vomiting

• Anorexia

• Peptic ulcer disease [10]

• Pancreatitis

• Neuropsychiatric symptoms such as anxiety, depression, fatigue, and cognitive dysfunction

  • Somnolence

  • Obtundation and coma indicate progression to hypercalcemic crisis

• Diminished muscle excitability

  • Cardiac arrhythmias

  • Muscle weakness, paresis

• Polyuria and dehydration

The presentation of hypercalcemia includes stones (nephrolithiasis), bones (bone pain, arthralgias), thrones (increased urinary frequency), groans (abdominal pain, nausea, vomiting), and psychiatric overtones (anxiety, depression, fatigue). Note that these are also the findings of vitamin D overdose!