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Hypercalcaemia - Management
How should I manage a person with hypercalcaemia without a confirmed cause?

  • If the person has severe hypercalcaemia (adjusted serum calcium concentration greater than 3.40 mmol/L) or symptomatic hypercalcaemia, admit immediately to hospital.
  • If the person has asymptomatic, mild or moderate hypercalcaemia (adjusted serum calcium concentration 3.40 mmol/L or less):
    • Repeat the serum calcium concentration after 1 week to exclude rapidly evolving hypercalcaemia that is suggestive of cancer and requires admission to hospital.
    • If cancer is suspected, refer urgently (to be seen within 2 weeks) to the appropriate specialist. See the CKS topics in the clinical speciality on Cancer - suspected (NICE referral advice).
    • If primary hyperparathyroidism is suspected, see Primary hyperparathyroidism.
    • If familial hypocalciuric hypercalcaemia is suspected, refer the person to an endocrinologist.
    • If the person has known renal failure (stage 5 chronic kidney disease), refer them to their renal specialist. See the CKS topic on Chronic kidney disease - not diabetic.
    • If renal failure is detected which was not previously known (not a typical presentation of hypercalcaemia), consider admitting the person to hospital or referring them urgently to a renal specialist (depending on the symptoms and likely speed of onset).
    • If the person is taking any drugs that may be contributing to the hypercalcaemia, stop them if appropriate and recheck the serum calcium.
      • If milk-alkali syndrome is suspected, consider admitting the person to hospital for correction of fluid and electrolyte abnormalities.
      • If the person is taking lithium, contact their mental health specialist to discuss whether to stop the lithium, monitor the serum calcium, or refer to an endocrinologist.
      • If hypercalcaemia is due to vitamin D ingestion, it may take many weeks for the serum calcium concentration to return to normal after discontinuing vitamin D.
      • If the adjusted serum calcium remains high after discontinuation of the drug, look for another underlying cause or refer to an endocrinologist or other appropriate specialist.
    • If non-parathyroid endocrine disease is suspected as the cause of hypercalcaemia, refer the person to an endocrinologist. Admission to hospital or urgent referral may be required (for example if Addison's disease or thyrotoxicosis are suspected).
    • If immobilization in Paget's disease is suspected:
      • Address the immobilization, if possible, and monitor the person's serum calcium concentration.
      • If mobilization is not possible, or the person's serum calcium concentration remains increased, refer the person to an endocrinologist, rheumatologist, or specialist in bone disease.
    • If sarcoidosis is suspected, refer the person to a respiratory specialist (or other specialist depending on disease manifestation).
    • If tuberculosis is suspected, see the CKS topic on Tuberculosis.
    • If a cause is not clear (for example, because the parathyroid hormone level is normal), refer the person to an endocrinologist.

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