90% of hypercalcaemia is due to either malignancy or hyperparathyroid.

Severity: Adjusted Calcium (Ca)

  • Severe: >3.5mmol/l – URGENT treatment (risk of dysrhythmia)
  • Moderate: 3.0-3.5mmol/l  – PROMPT treatment (maybe well tolerated if chromic)
  • Mild: <3.0mmol/l  – doesn’t require urgent treatment and often asymptomatic


  • Brain: Mood change, Reduced GCS
  • CVS: Dysrhythmias, Hypertension
  • GIT: Anorexia, Vomiting, Constipation, Pancreatitis, Peptic ulcer
  • Renal: Thirst, Renal impairment, Renal Stones
  • MSK: Muscle weakness

ECG Changes

  • QT short
  • PR prolonged > AV block
  • Wide QRS


  • 0.9% NaCl – may need 4-6l in 24hrs, requires close monitoring
  • Consider Zoledronic acid or Pamidronate – if fluid does not work


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