*4.2.1 Introduction*


• Initial volume resuscitation is essential since hypercalcemia typically causes volume depletion due to enhanced fluid excretion by the kidneys and reduced oral intake. Plasmalyte is a good choice since it is a balanced crystalloid which does not contain calcium. Lactated ringer contains calcium and normal saline can cause acidosis (possibly increasing risk of renal injury) therefore both are

• Mild to moderate hypercalcemia without symptoms does not require

contributing medication discontinued. Immobility may exacerbate

aggressive treatment. The underlying disease should be treated, and potentially

• In patients with severe hypercalcemia, IV fluid hydration (at least 2-4 L/day for 1-3 days) should be given in association with bisphosphonates and

• Bisphosphonates block calcium release from bones causing unidirectional uptake by the bones. These take days to work and should be started early. Bisphosphonates should be avoided in patients with increased calcium intake (milk-alkali syndrome. The main side effect is renal failure however the most common is flu-like syndrome which can be treated symptomatically. Various options are pamidronate 60-90 mg IV or zoledronic acid 4 mg IV [41, 42].

• Calcitonin is an excellent agent to control severe symptomatic hypocalcemia while waiting for bisphosphonates to take effect. These work by reducing bone calcium reabsorption and cause a temporary reduction in calcium. Calcitonin can cause nausea, vomiting and flushing. For adults, calcitonin 4 U/kg

suboptimal compared to plasmalyte (see **Figure 8**).

*Electrolytes in the ICU*

*DOI: http://dx.doi.org/10.5772/intechopen.96957*

hypercalcemia therefore patients should be mobilized.

calcitonin to reduce serum calcium levels.

**Figure 8.**

**153**

*Treatment of hypercalcemia.*

3.Hypercalcemic Crises:- Total calcium >14 mg/dl or ionized calcium >10 mg/dl.
