A patient with hypercalcemia complains of constipation and fatigue. Explain the mechanistic relationship between high calcium intake and gastrointestinal symptoms.

Excess calcium increases intestinal pH dramatically causing enzyme inactivation and acute malabsorption syndrome

High calcium triggers immediate release of gastrin which causes diarrheal symptoms rather than constipation

Hypercalcemia increases bile secretion which directly causes constipation and decreased appetite

High serum calcium can slow smooth muscle contractility in the GI tract and excess unabsorbed calcium in the lumen can alter motility and cause constipation and bloating