Therapeutic target
- Correction of hypercalcemia
Therapy recommendations
- Treatment of the underlying cause (e.g., primary hyperparathyroidism).
- In symptomatic hypercalcemia (usually above 11.5 mg/dl (≥ 2.9 mmol/l)), blood calcium levels should be lowered.
The following therapy recommendations apply in tumor hypercalcemia as well as in hypercalcemic crisis (total serum calcium of >3.5 mmol/l):
- Rehydration: 2-4 l NaCl 0.9%/ 24 h i. v. (+ potassium).
- Enhancement of calcium excretion
- Drinking amount 2-3 l
- 2-3 l NaCl 0.9% i. v.
- 40-80 mg furosemide i. v.
- Inhibition of bone resorption
- Bisphosphonates i. v. to slow osteolysis.
- Calcitonin (parathyroid hormone antagonist): inhibition of calcium release from bone by reducing the activity of osteoclasts (giant cells responsible for bone resorption and demineralization).
- Inhibition of calcium absorption
- 100 mg prednisolone i. v./oral
- Low calcium diet
- Elimination of calcium from the circulation.
- Dialysis against low-calcium dialysate (exceptional case!).
Caveat. Caution should be exercised in patients taking digitalis glycosides. The toxicity of digitalis glycosides is increased by hypercalcemia.
