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How to Treat Hypercalcaemia?

Medical Treatment:
Patients with moderate/severe hypercalcaemia should be kept well hydrated and may need several litres of fluid.
Avoid thiazide diuretics as they increase serum calcium concentration. The addition of furosemide has not been shown to be of benefit.
For symptomatic hypercalcaemia:
* Sodium chloride solution 0.9%, IV infusion, 4-6 L in 24 hours.
  • Monitor urine output.
If still symptomatic after 24 hours and adequate hydration, or if initial serum calcium is greater than 3 mmol/L:
Bisphosphonates (specialist initiated) e.g:
* Pamidronic acid, IV infusion, 15-30 mg over 4 hours according to plasma calcium concentration.
  • Dilute each 15 mg in 125 mL sodium chloride solution 0.9% and administer over 1 hour.
  • Doses should not be repeated until after 7 days.
  • A response is noted within 48 hours and trough reached in 5-7 days.
In patients with granulomatous disease and haematological malignancies:
* Prednisone, oral, 40 mg daily.

When to refer:
  • When a diagnosis of hyperparathyroidism is confirmed or other cause is not obvious.