In parathyroid crisis with sudden elevations of calcium over 16 mg/dl; the treatment consist of:

Hypercalcemic Crisis: Patients with PHPT may occasionally present acutely with nausea, vomiting, fatigue, muscle weakness, confusion, and a decreased level of consciousness; a complex referred to as hypercalcemic crisis. These symptoms result from severe hypercalcemia from uncontrolled PTH secretion, worsened by polyuria, dehydration, and reduced kidney function and may occur with other conditions causing hypercalcemia.\ Calcium levels are markedly elevated and may be as high as 16 to 20 mg/dl. Parathyroid glands tend to be large or multiple, and the tumor may be palpable. Patients with parathyroid cancer or familial HPT are more likely to present with hypercalcemic crisis. Treatment: Treatment consists of therapies to lower serum calcium levels followed by surgery to correct HPT. Mainstay of therapy: Rehydration with a 0.9% saline and diuresis with furosemide. Other drugs used to lower serum calcium levels: Bisphosphonates, Calcitonin Mithramycin (Plicamycin), Gallium nitrate Glucocoicoids Ref: Harrison&;s 19th edition PGno: 2478