Table 3.

Symptomatic treatment of hypercalcemiaa

TypeMeasure/SubstanceDosageSpecific IndicationMode of ActionSide Effects, Complications
aHHM, humoral hypercalcemia of malignancy; iv, intravenous. Digitalis and hydrochlorothiazides are contraindicated during hypercalcemia.
Fast-acting
diureticDrinking of fluids low in calcium2 to 3 liters/dUniversalIncrease in calciuriaNone
IV infusion of saline4 to 6 (10) liters/dUniversalIncrease in calciuria (via natriuresis)Volume expansion, hypokalemia, hypomagnesemia
Furosemide20 to 40 to 500 mg/dUniversal in cases of fluid retentionIncrease in diuresis and calciuriaHypomalemia, hypomagnesemia
100 mg/hr → 24 hSameDirect stimulation of calciuriaSame
antiresorptiveBisphosphonates clodronate300 mg iv in 6 to 8 h for 2 to 6 daysUniversal (in preference in HHM)Inhibition of osteolysisIn cases of too fast administration, renal insufficiency
400 to 3200 mg orally for days or weeksSameSameRarely gastrointestinal complaints
pamidronate15 to 90 mg iv in 4 to 6 hSameSameSame, occasionally feverish reaction
ibandronate2 to 6 mg iv in 2 hSameSameNone
Calcitonin200 to 500 IU/dUniversal (adjuvant drug)Inhibition of osteolysisNausea, vomiting, escape phenomenon
Mithramycin, mostly replaced by bisphosphonates25 μg/kg iv daily for 3 to 4 dIn preference in HHM, parathyroid carcinomaInhibition of osteolysisThrombopenia, leukopenia, liver and kidney damage
extractiveHemodialysisCa2+ -free dialysateHypercalcemic crisis and renal insufficiencyDialysis of Ca2+ from the circulationDialysis-related
Slow-acting
anti-absorptiveDiet low in Ca2+ and vitamin D<100 mg Ca2+/dUniversalDecrease in Ca2+ supply and absorptionNone
Prednisone40 to 100 mg/dVitamin D intoxication, sarcoidosis (rarely HHM)Decrease in Ca2+ absorption, increase in calciurialatrogenic Cushing's syndrome