What is the treatment approach to hypercalcemia in the emergency department?

Updated: Apr 11, 2018
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The initial step in the care of severely hypercalcemic patients is hydration and forced calciuresis. Because most of these patients are profoundly dehydrated, 0.9 normal saline is the crystalloid of choice for rehydration.

A loop diuretic (eg, furosemide) may be used with hydration to increase calcium excretion. This may also prevent volume overload during therapy.

Bisphosphates will inhibit osteoclast activity for up to a month. However, these agents may take 48-72 hours before reaching full therapeutic effect. [5]


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