Hypercalcemia ( Raised calcium ) : Acute management

Hypercalcemia Definition

Adjusted serum calcium >2.60 mmol/L (10.4 mg/dL)
Symptoms vary depending on the severity and rate of onset of hypercalcemia.

Hypercalcemia refers to elevated calcium levels in the blood, which can disrupt multiple physiological systems. Calcium plays a pivotal role in muscle contraction, nerve transmission, bone health, and hormone regulation. When blood calcium levels rise above normal, this balance is disturbed, leading to widespread symptoms across organ systems.

Level of Severity	Adjusted Serum Calcium	Serum Calcium mg/dL	Clinical Features	Management
Mild	2.60 - 3.00 mmol/L	10.4 - 12 mg/dL	Often asymptomatic. Symptoms may include fatigue and mild polyuria.	Often does not require urgent correction. Review medications (thiazides, calcium supplements). Encourage oral hydration. Monitor calcium levels regularly.
Moderate	3.00 - 3.40 mmol/L	12 - 13.6 mg/dL	May present with gastrointestinal (nausea, constipation), renal (polyuria, dehydration), and neurological (confusion, fatigue) symptoms.	Rehydrate with IV fluids (0.9% sodium chloride), typically 4-6 liters over 24 hours. Assess fluid status after 24 hours. If needed, consider IV bisphosphonate (e.g., Zoledronic acid).
Severe	>3.40 mmol/L	>13.6 mg/dL	High risk of life-threatening complications such as arrhythmias, coma, or renal failure. Patients often symptomatic with significant dehydration, confusion, or cardiac issues.	Urgent rehydration with IV fluids. Administer...

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