Day 3 - Hypercalcemia

Pillars of Management

Calcium < 3.0mmol rarely causes symptoms

1. Volume resuscitation

   1. Goal is to maximize urine output with aggressive IV rehydration

      1. Administer 1-2L normal saline bolus then continue 200-250mL/hr to target urine output 100-150mL/hr

      2. If there are concerns about volume overload can administer furosemide IV to facilitate ongoing volume administration

2. Treatment of underlying cause

   1. Discontinue medications that cause hypercalcemia ie. supplements, lithium, thiazide diuretics, vitamin D

   2. Investigate potential causes and treat where possible, ie. multiple myeloma, hyperparathyroidism, bony metastases, tuberculosis, sarcoidosis

3. If ongoing severe hypercalcemia:

   1. Calcitonin - 4units/kg/day in 2 divided doses for immediate effect (works within 6hrs)

      1. Will develop tachyphylaxis within 36-48hrs, therefore, used to temporize but not for ongoing management

   2. Bisphosphonates - pamidronate 60-90mg IV or zoledronate 4mg IV

      1. Requires 24-48hrs to take effect, reaches peak effect within 1 week

   3. Consider corticosteroids ie. prednisone 10-40mg po in granulomatous diseases

4. If refractory severe hypercalcemia or unable to tolerate fluids, consider hemodialysis