Treatment of Hypercalcemia with Corrected Serum Calcium ≥3.0 mmol/L or Shortened QT Interval on ECG
Clinical Scenario
This protocol applies when corrected serum calcium reaches 3.0 mmol/L or above (moderate to severe), or when hypercalcaemia is symptomatic — presenting with lethargy, coma, or electrocardiographic changes including a shortened QT interval.
Severity thresholds: Mild 2.55–2.9 mmol/L · Moderate 3.0–3.2 mmol/L · Severe above 3.2 mmol/L (corrected serum calcium)
Treatment Approach
The initial intervention involves intravenous rehydration. Fluid volume is titrated against a defined urine output target — the complete management sequence, monitoring parameters, and decision thresholds are contained within the full protocol.
Clinical Goal
Treatment is targeted at maintaining urine output greater than 60 mL/hr.
References
HYPERcalcaemia (Mild: 2.55–2.9 mmol/L, Moderate: 3.0–3.2 mmol/L, Severe: more than 3.2 mmol/L corrected)
Moderate to severe or symptomatic hypercalcaemia (e.g. lethargy, coma, ECG changes [shortened QT interval])
Rehydration – intravenous sodium chloride 0.9%.
Volume infused should be sufficient to maintain a urine output greater than 60 mL/hr.
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