Hydration

Hydration with intravenous crystalloid (typically 0.9% sodium chloride) is the first step in the acute management of hypercalcaemia. Most patients suffering from acute hypercalcaemia are volume contracted. Administration of cystralloid is important because it expands intracellular volume, diluting plasma calcium and increasing renal perfusion and renal calcium clearance. The optimal administration rate of normal saline is determined by the severity of hypercalcaemia, the degree of volume contraction, the ability of the patient to tolerate fluid, and the overall clinical status of the patient. Relatively large volumes of crystalloid may be required: 1-2L as a bolus, and 200-500ml per hour thereafter. [5]