Additional treatment

If severe hypercalcaemia in a child does not respond adequately to rehydration, seek specialist advice.

In an adult with severe hypercalcaemia (of any cause) that has not responded to rehydration, consider using an intravenous bisphosphonate infusion to temporarily lower the serum calcium concentration. Before starting a bisphosphonate, take a blood sample to measure the patient’s parathyroid hormone concentration to help determine the cause of hypercalcaemia. For the bisphosphonate infusion, use:

Patients must be well hydrated before receiving bisphosphonate therapy.

The bisphosphonate infusion can cause transient influenza-like symptoms. This most often occurs after the first dose, and is less likely to occur with subsequent doses. To reduce the severity of the reaction, advise patients to take paracetamol before and for several days after the infusion.

In acute life-threatening hypercalcaemia, consider parenteral calcitonin salmon (salcatonin) in addition to the bisphosphonate to achieve a more rapid effect. Calcitonin salmon (salcatonin) becomes less effective with repeated doses and is usually ineffective after several days of use. Use:

Glucocorticoids may be required in refractory hypercalcaemia caused by malignancy, vitamin D toxicity or sarcoidosis. Severe hypercalcaemia complicated by kidney failure can require dialysis. Seek specialist advice.