Treatment of acute hypercalcemia-

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