Hypercalcemia in the Emergency Department: Evidence-Based Diagnosis and Acute Management
Abstract:
Introduction: Hypercalcemia is a life-threatening electrolyte imbalance that frequently presents to the Emergency Department (ED). Approximately 90% of cases are attributed to primary hyperparathyroidism and malignancy.
Purpose: The aim of this updated review is to summarize diagnostic and therapeutic management strategies based on current international guidelines.
Method: Narrative synthesis of literature published between 2010–2025, with a clinical focus on ED management.
Results: The diagnosis should be confirmed with ionized calcium assessment, disease severity categorization, and electrocardiography (ECG). Acute management comprises isotonic saline hydration, calcitonin bridging, and definitive antiresorptive (zoledronic acid or denosumab). In calcitriol-mediated disease, glucocorticoids are the therapy of choice; dialysis is indicated if refractory or severe. Guided goal-directed fluid therapy with point of-care ultrasound (POCUS) minimizes iatrogenic injury.
Conclusion: A stepwise, risk-stratified ED algorithm that incorporates fluids, pharmacotherapy, POCUS-guided evaluation, and escalation criteria maximizes safety and outcomes in hypercalcemic emergencies.
