From the FDA Drug Label
Reducing excessive bone resorption and maintaining adequate fluid administration are, therefore, essential to the management of hypercalcemia of malignancy
- Patient education for Hypercalcemia includes:
- Maintaining adequate fluid administration
- Reducing excessive bone resorption 1
From the Research
Hypercalcemia patients should increase their fluid intake to at least 2-3 liters of water daily and reduce dietary calcium by limiting dairy products, calcium-fortified foods, and calcium supplements, unless otherwise directed by their healthcare provider, as the initial step in managing their condition. This approach is based on the most recent and highest quality study available, which emphasizes the importance of hydration and dietary modifications in managing hypercalcemia 2.
Key Recommendations
- Increase fluid intake to help flush excess calcium through the kidneys
- Reduce dietary calcium to minimize calcium intake
- Avoid thiazide diuretics like hydrochlorothiazide, which can worsen hypercalcemia
- Increase physical activity to prevent calcium leaching from bones into the bloodstream
- Take medications as prescribed, which may include bisphosphonates like zoledronic acid or pamidronate, calcitonin, or cinacalcet, depending on the cause of hypercalcemia
Monitoring and Treatment
- Monitor for worsening symptoms such as severe confusion, extreme fatigue, or irregular heartbeat, which require immediate medical attention
- Regular blood tests are essential to track calcium levels and ensure treatment is effective
- The underlying cause of hypercalcemia, such as hyperparathyroidism, certain cancers, or medication side effects, will determine the specific long-term treatment plan
- In cases of severe hypercalcemia, saline hydration, and intravenous bisphosphonates like zoledronic acid may be necessary, as shown in a recent study 3
Underlying Causes and Treatment
- Primary hyperparathyroidism and malignancy are responsible for greater than 90% of all cases of hypercalcemia 4
- Treatment of hypercalcemia should be started with hydration, and loop diuretics may be required in individuals with renal insufficiency or heart failure to prevent fluid overload 4
- Calcitonin is administered for the immediate short-term management of severe symptomatic hypercalcemia, and bisphosphonates like zoledronic acid or pamidronate are used for long-term control of severe or symptomatic hypercalcemia 4