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Nate Friedman, MD
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HyperCa plan

﻿‍Repeat calcium level (ionized + total)﻿ 
﻿‍Review offending medication﻿ ‍thiazide diuretic﻿ ‍Phenytoin﻿ ‍Lithium﻿  
﻿‍Hydrate well﻿ 
﻿‍CBC, Chemistry, Calcium, Mg, Phosphorus, LFTs, Albumin, TSH, CRP, SR, U/A﻿ ‍PTH, 25-hydroxy-vitamine D﻿ 
﻿‍Urine calcium and 24 hrs urine calcium﻿ if elevated PTH 
﻿‍Chest X-ray﻿ for granulomatous disease
﻿‍Bone scan﻿ 
﻿‍PSA﻿ ‍Mammogram﻿ ‍CT thorax-abdomen-pelvis﻿ in search for malignancy
﻿‍Hematologist-Oncologist referral﻿ if MGUS
If moderate hypercalcemia > 12 (3.0)
﻿‍ECG﻿ 
﻿‍Endocrinology referral﻿ 
If severe hypercalcemia > 10 (3.0) or symptomatic
﻿‍Emergency referral﻿ 
﻿‍Saline bolus 1000cc﻿ ‍followed by Lasix 10mg iv﻿ 
﻿‍Calcitonine 4 units/kg sc/im q 6 hrs for 24 hrs﻿ 
﻿‍Solumedrol 125mg iv x1﻿ if from malignancy etiology
﻿‍Pamidronate (Aredia) 60mg in 500cc saline over 3 hrs﻿ if from malignancy etiology
﻿
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