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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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