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Patient Care Process for the Management of Hypercalcemia



  • Patient characteristics (e.g., age, race, sex,)

  • Patient history (past medical, family, social—dietary habits)

  • Evaluate symptoms (see Hypercalcemia-Clinical Presentation)

  • Current medications, including over-the-counter medications, herbal products, nutritional supplements

  • Objective data (see Hypercalcemia-Clinical Presentation)

    • Blood pressure, heart rate, height, weight

    • Labs (serum calcium and albumin, ionized calcium (if available))

    • Other diagnostic tests when indicated (e.g., ECG)


  • Plausible etiology for hypercalcemia (see Table 50-1)

  • Acuity of symptoms and urgency for treatment (see Figure 50-2)

  • Current medications and dietary intake that may contribute to or worsen hypercalcemia

  • Kidney function (e.g., creatinine clearance)

  • Serum calcium goal


  • Pharmacotherapy based on etiology of hypercalcemia, acuity of symptoms urgency of treatment, and kidney function

    • Determine specific dose, route of administration, frequency of administration, and anticipated duration of treatment (see Table 50-2)

  • Monitoring parameters including efficacy (e.g. reduction in serum calcium, resolution of symptoms), safety (medication-specific adverse effects), and timeframe (see Table 50-2)

  • Patient education (e.g., purpose of treatment, drug therapy, expected time to reduce calcium, need for future medications)


  • Provide patient education regarding all elements of treatment plan

  • Schedule follow-up according to etiology of hypercalcemia, acuity of original symptoms, and urgency for treatment

Follow-up: Monitor and Evaluate

  • Measure serum calcium to determine response

  • Presence of adverse effects

  • Consider alternative pharmacotherapy if efficacy goals not achieved or adverse effects observed

*Collaborate with patient, caregivers, and other health professionals



  • image Severe acute hypercalcemia can result in cardiac arrhythmias, whereas chronic hypercalcemia can lead to calcium deposition in soft tissues including blood vessels and the kidney.

  • image The correction of hypercalcemia can include multiple pharmacotherapeutic modalities such as hydration, diuretics, bisphosphonates, and steroids, depending on the etiology and acuity of the hypercalcemia.

  • image Hypocalcemia is typically associated with an insidious onset; however, some drugs such as cinacalcet are associated with rapid decreases in serum calcium.

  • image Acute treatment of hypocalcemia requires calcium supplementation whereas chronic management may require other therapies such as vitamin D to maintain serum calcium values.

  • image Hyperphosphatemia occurs most frequently in patients with chronic kidney disease (CKD).

  • image Treatment of nonemergent hyperphosphatemia includes the use of phosphate binders to decrease absorption of phosphorus from the gastrointestinal (GI) tract.

  • image Hypophosphatemia is a relatively common complication among critically ill patients.

  • image Treatment of acute hypophosphatemia usually requires IV supplementation of phosphorous salts.

Disorders of calcium and phosphorus are common complications of multiple acute and chronic diseases. These disorders are frequently seen in the acute care setting; however, they are also often present in ambulatory patients, usually in a less severe state. The consequences of electrolyte disorders can range from asymptomatic to life-threatening, requiring hospitalization and emergent treatment. The maintenance of fluid and electrolyte homeostasis requires adequate functioning and modulation by multiple hormones on tissues of multiple organ systems.

There are many common drug therapies that can disturb the ...

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