Hypercalcaemia Overview

  • Normal serum corrected calcium = 2.1 – 2.6 mmol/L
  • Mild hypercalcaemia = 2.7 – 2.9 mmol/L
  • Moderate hypercalcaemia = 3.0 – 3.4 mmol/L
  • Severe hypercalcaemia = greater than 3.4 mmol/L

Causes of Hypercalcaemia

  • Hyperparathyroidism (primary and tertiary)
  • Myeloma
  • Bony metastases
  • Paraneoplastic syndromes
  • Milk-alkali syndrome
  • Sarcoidosis
  • Excess vitamin D (e.g. iatrogenic)

ECG Changes in Hypercalcaemia

ECG-QT-changes-Hypocalcaemia-Hypercalcaemia 2

ECG Examples

Example 1
ECG Osborn waves in severe hypercalcaemia


Example 2
  • Hypercalcaemia causing marked shortening of the QT interval (260ms).
  • Image originally featured in Kyuhyun (K.) Wang’s excellent Atlas of Electrocardiography.

Example 3
ECG Hypercalcaemia 2

This is the ECG of a 41-year old man with a parathyroid adenoma who presented to ED critically unwell with a serum calcium of 6.1 mmol/L. He suffered a VF arrest not long after this ECG was taken. The ECG shows:

  • Bizarre-looking QRS complexes
  • Very short QT interval
  • J waves = notching of the terminal QRS, best seen in lead V1

Many thanks to Dr James Hayes, FACEM, for this fantastic ECG!

Related Topics

  • Slovis C, Jenkins R. ABC of clinical electrocardiography: Conditions not primarily affecting the heart. BMJ. 2002 Jun 1;324(7349):1320-3. [PMC1123277]
  • Otero J, Lenihan DJ. The “normothermic” Osborn wave induced by severe hypercalcemia. Tex Heart Inst J. 2000;27(3):316-7. [PMC101092]

LITFL Further Reading

Advanced Reading




Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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