Treatment of acute hypercalcemia-
Normal saline with forced diuresis with chlohiazide
Plicamycin
Gallium nitrate
Mithramycin
Hypercalcaemic Crisis It may be the mode of presentation in primary hyperparathyroidism especially in elderly. It presents with dehydration, hypotension, abdominal pain, vomiting, fever, altered sensorium. It is a medical emergency.Management Medical Management 1.Rehydration until serum calcium level falls (4-6 litres of normal saline in first 24 hrs) 2.Correct electrolyte imbalance and give frusemide 100 mg 1-2 hours 3.Other methods to decrease serum calcium are: a.Salmon calcitonin 200-400 IU 8 hourly subcutaneously b.Mithramycin 25 ug/kg IV c.Neutral phosphate IV (500 ml over 6-8 hrs) 4.Avoid drugs like digoxin (hypercalcaemia and hypocalcaemia may potentiate its toxicity), thiazides (decrease the calcium excretion), vitamin A, D (increase the bone turnover) oestrogen and antioestrogen. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE 4TH EDITION PAGE NO - 631
Endocrinology