Back to Basics: Hypercalcemia

Calcium was found to be 13.1 mg/dL


  • Total calcium >10.5mg/dL, usually asymptomatic when less than 12
  • Ionized calcium >2.7 mEq/L
  • More commonly associated with hyperparathyroidism or malignancy

Stones, Bones, Moans and Groans!

  1. General - malaise, weakness, dehydration
  2. Neurologic - confusion, headache, depression, hallucinations, hyporeflexia
  3. Skeletal - bone pain, deformities Cardiovascular - hypertension, QT shortening, wide T wave, ST depression
  4. Gastrointestinal - nausea, vomiting, constipation, abdominal pain, PUD, pancreatitis
  5. Urologic - polyuria, renal insufficiency, nephrolithiasis

Corrected calcium (mg/dL) = measured total Ca+2 + 0.8 (4.0 - serum albumin (g/dL)

Symptomatic patient or asymptomatic with Ca+2 >14 mg/dL, treat with volume repletion

  1. 0.9% NS at 500-1000 mL/h for 2-4 hours
  2. Furosemide (20- 40mg) for diuresis
  3. Corrent K and Mg
  4. Corticosteroids (prednisone 1-2mg/kg PO or hydrocortisone 200-300mg IV) to reduce mobilization of calcium from bone (in Addison’s)
  5. IV bisphosphonates for hypercalcemia assoc with malignancy



Petrion R, Marino R. "Fluids and Electrolytes." Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et. al. New York, NY: McGraw-Hill, 2016, pg109-10.