Which is a major neuromuscular symptom of hypercalcemia?

• A. Weakness
• B. Nausea
• C. Palpitations
• D. Polyuria

Answer: (A)

Elevated calcium reduces neuromuscular excitability by raising the membrane threshold and stabilizing the muscle and nerve membranes, leading to proximal muscle weakness and fatigue. This weakness is the most characteristic neuromuscular finding in hypercalcemia, often with decreased reflexes. Nausea, palpitations, and polyuria are seen in hypercalcemia as well, but they reflect gastrointestinal, cardiac, and renal effects rather than the neuromuscular dysfunction. Thus, weakness best captures the neuromuscular impact of high calcium levels.