From the Research
Hypercalcemia Treatment Threshold
The level of hypercalcemia at which treatment needs to be initiated is not strictly defined, but several studies provide guidance on this issue.
- Mild hypercalcemia, defined as total calcium of less than 12 mg/dL (<3 mmol/L) or ionized calcium of 5.6 to 8.0 mg/dL (1.4-2 mmol/L), usually does not require acute intervention 1.
- However, symptomatic or severe hypercalcemia, defined as total calcium of 14 mg/dL or greater (>3.5 mmol/L) or ionized calcium of 10 mg/dL or greater (≥2.5 mmol/L), requires immediate treatment 1, 2.
- Treatment is often initiated when serum calcium levels are greater than or equal to 12 mg/dL 3.
- In patients with severe hypercalcemia, treatment should be initiated promptly to prevent life-threatening complications 2, 4.
- The decision to treat and the extent of treatment depend on factors such as the degree of hypercalcemia, severity of symptoms, and the underlying cause 5.
Treatment Options
Treatment options for hypercalcemia include:
- Hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate, for symptomatic or severe hypercalcemia 1, 5.
- Glucocorticoids for hypercalcemia due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas) 1.
- Denosumab and dialysis for patients with kidney failure 1.
- Rehydration with normal saline, loop diuretics, calcitonin, steroids, and calcimimetics for hypercalcemic crisis 4.
- Definitive correction of the underlying cause, such as surgery for primary hyperparathyroidism or anti-tumour therapy, is important in controlling chronic hypercalcemia 5.