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Hypercalcaemia - Management
How should I manage a person with hypercalcaemia who has known cancer?

  • Consider whether it is appropriate to treat the hypercalcaemia.
    • Treatment may not be appropriate if the person was deteriorating rapidly (day-by-day) before they developed hypercalcaemia.
  • If the person has symptomatic hypercalcaemia, or moderate or severe hypercalcaemia (adjusted serum calcium concentration greater than 3.0 mmol/L) — if appropriate, admit immediately to hospital or a hospice (preferably involving the person's specialist).
    • Intravenous fluids and bisphosphonates (with or without other treatment) are required. See Secondary care.
  • If the person has asymptomatic, mild hypercalcaemia (adjusted serum calcium concentration 3.0 mmol/L or less), seek immediate specialist advice. The specialist may advise immediate admission or planned admission over the next few days.
    • If immediate admission is not necessary:
      • Provided there are no contraindications (such as severe renal impairment or heart failure), advise the person to maintain good hydration by drinking 3–4 L of fluid per day.
      • Reassure the person that it is not necessary to adopt a low calcium diet.
      • Advise the person to immediately report any symptoms of hypercalcaemia.
      • Encourage mobilization, if possible.
      • Advise the person to avoid any medications or vitamin supplements that could worsen hypercalcaemia.

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