What is the initial treatment for severe symptomatic hypercalcemia?

The initial treatment for severe symptomatic hypercalcemia primarily involves intravenous hydration with normal saline. This approach is essential for several reasons.

First, hypercalcemia often leads to dehydration, as elevated calcium levels can cause renal impairment and decreased kidney function. Hydration helps to improve renal perfusion, facilitating calcium excretion through the kidneys. By administering IV normal saline, you provide volume replacement that enhances glomerular filtration and promotes the excretion of excess calcium from the body.

Second, this treatment helps to quickly correct electrolyte imbalances that may arise due to hypercalcemia, such as effects on other electrolytes and dehydration. The administration of normal saline not only hydrates but also aids in symptom relief, as symptoms of hypercalcemia can include nausea, vomiting, confusion, and lethargy.

Other interventions, such as pharmacological treatments (like bisphosphonates or calcitonin), may be considered after initial hydration, especially in acute settings or when the hypercalcemia is due to malignancy. However, supportive care and volume expansion with fluids take precedence in the initial management of severe symptomatic hypercalcemia.