Acute Management of Hypercalcemia

Both acute and severe hypercalcemia should be regarded as life-threatening emergencies with a significant mortality risk; patients invariably require hospitalization and urgent therapeutic intervention. Primary hyperparathyroidism and malignancy-associated hypercalcemia are the two most frequent clinical situations in which severe hypercalcemia may develop. Symptoms of hypercalcemia, which vary among patients, are related to several factors, such as the absolute concentration and the rate of rise in serum calcium, the age of the patient, and comorbidities. The clinical manifestations reflect disturbances in central nervous system, gastrointestinal, renal, and cardiovascular function. Intravenous hydration, bisphosphonates, and calcitonin are all first-line therapies. In patients with hypercalcemia due to exogenous or endogenous vitamin D intoxication, glucocorticoids can be very effective. Finally, in cases of life-threatening hypercalcemia, when other approaches have not been successful, dialysis may be necessary. If the life-threatening hypercalcemia is due to a parathyroid crisis, urgent parathyroidectomy may be indicated after the patient has been stabilized.