What is the first step in managing hypercalcemia?

In the management of hypercalcemia, the first and most crucial step is hydration with saline. Hypercalcemia can lead to various complications, including renal impairment and altered mental status, and the immediate goal is to help restore normal calcium levels as well as support kidney function.

Hydration with saline aids in the dilution of serum calcium levels and promotes renal excretion of calcium. By providing intravenous fluids, you increase the glomerular filtration rate, which can help the body to eliminate excess calcium more effectively. This step is particularly important in cases of symptomatic hypercalcemia or when patients present with signs of dehydration, as fluid depletion can exacerbate the condition.

Other treatment options, such as bisphosphonate therapy, surgical intervention, or vitamin D therapy, may be indicated later based on the underlying cause of the hypercalcemia and the patient’s clinical status, but hydration should always be the initial approach in the acute setting to stabilize the patient and prepare for subsequent management.