Hypercalcemia in malignancy

Causes:

1. PTHrP
2. Direct  bone metastasis
3. Ectopic PTH secretion 

Investigation:

• S calcium with albumin 

Medical management of severe hypercalcaemia (ABCD)

1. Adequate hydration 

• IV 0.9% saline 2–4 L/day  
• improve renal function
• increase renal calcium excretion 

1. Bisphosphonate

• Zoledronic acid 4 mg IV or pamidronate 60–90 mg IV  
• inhibit bone resorption 

1. Calcitonin 

• increase renal calcium excretion
• reduce bone resorption 
• for first 24-48 hours in life threatening hypercalcemia 

1. Denosumab

• severe, symptomatic hypercalcaemia that is refractory to zoledronic acid, 
• initial dose 60 mg SC, with repeat dosing based on response

Other option:

• Steroid 
• Loop diuretic for forced diuresis
• Hemodialysis