Hypercalcemia Treatment

Hypercalcemia management requires a tiered approach that balances immediate stabilization with long-term hormonal and cellular regulation. Initial treatment for symptomatic patients centers on aggressive volume expansion using isotonic saline at 250 mL/hr to counteract volume depletion, while loop diuretics like furosemide are reserved for patients with concurrent heart failure or edema. Rapid reduction of calcium levels is achieved through subcutaneous or intramuscular calcitonin, though its utility is limited to 48 hours due to tachyphylaxis. For sustained control, intravenous bisphosphonates like zoledronic acid inhibit osteoclast activity, while the monoclonal antibody denosumab offers an alternative for patients with renal impairment or refractory disease. Specialized therapies include cinacalcet for secondary hyperparathyroidism and glucocorticoids for sarcoidosis or lymphoma-related cases. Effective clinical practice involves stopping exacerbating medications like thiazides and lithium while prioritizing physical activity to minimize bone resorption.