For the management of hypercalcaemia in malignancy, or hypercalcaemia in palliative patients, see separate guidance available at www.palliativecareguidelines.scot.nhs.uk.
This guideline has been adapted for local use. The original guideline is available at:
Walsh J, Gittoes N, Selby P, the Society for Endocrinology Clinical Committee. Society for Endocrinology Endocrine Emergency Guidance: Emergency management of acute hypercalcaemia in adult patients. Endocrine Connect 2016 vol 5, no. 5, G9-G11 published under Creative Commons 4.0 license (http://www.endocrineconnections.com/). Accepted for publication 3rd August 2016. All modifications from the original guideline have been denoted below by # and should not be taken as an endorsement by the original authors.
Serum calcium concentration is tightly regulated within a normal reference range of between 2.2-2.6mmol/L.# Abnormalities of parathyroid function, bone resorption, renal calcium reabsorption or dihydroxylation of vitamin D may cause the regulatory mechanisms to fail and serum calcium to rise. Serum calcium is bound to albumin and measurements should be adjusted for serum albumin. Ninety percent of hypercalcaemia is due to primary hyperparathyroidism or malignancy.#
Adjusted calcium <3mmol/L: often asymptomatic and does not require urgent correction, however discuss with the endocrine team.#
Adjusted calcium 3-3.5mmol/L: may be tolerated if level has risen slowly, however may be symptomatic and prompt treatment is usually indicated.#
Adjusted calcium >3.5mmol/L: requires urgent correction due to the risk of dysrhythmia and coma.#
Clinical features of hypercalcaemia include:
This should be considered if further treatment is required after IV sodium chloride.#
N.B. Neither agent is licensed for use in non-tumour induced hypercalcaemia.#
There are other medicines that can be considered on a case by case basis (e.g. glucocorticoids as they inhibit 1,25OH vitamin D production, calcimimetics, parathyroidectomy) but seek specialist advice.#
Guideline reviewed: February 2023
Page last updated: March 2023