Rapid Review: Hypercalcemia

Reviewed February 2024

Hypercalcemia

• Sx: bone pain (bones), kidney stones (stones), abdominal pain (groans), lethargy, psychosis (psychiatric overtones)
• ECG: shortened QT interval
• Most common causes
  • Malignancy (most common inpatient cause)
  • Primary hyperparathyroidism (most common outpatient cause)
• Treatment: IV fluids, bisphosphonates, calcitonin, denosumab (refractory disease)

Sample question:

A 62-year-old woman with nephrolithiasis presents to the emergency department with muscle weakness, nausea, and confusion. ECG reveals bradycardia with a shortened QT interval. Laboratory findings include a total calcium of 14.7 mg/dL. In addition to starting intravenous isotonic saline at 200 mL/hour, which of the following is the best treatment option?