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===Asymptomatic or Ca <12 mg/dL===
*Does not require immediate treatment
*Advise to avoid factors that can aggravate hypercalcemia (thiazide diuretics, Li, volume depletion, prolonged inactivity, high Ca diet)

===Mildly symptomatic Ca 12-14 mg/dL===
*May not require immediate therapy; however, an acute rise may cause symptoms necessitating treatment as described for severe hypercalcemia (see below)

===Symptomatic or Severe hypercalcemia (Ca >14 mg/dL)===
*Patients are likely dehydrated and require [[normal saline|saline]] hydration as initial therapy

====Hydration====
*Isotonic [[normal saline|saline]] at 200-300 mL/hour; adjust to maintain urine output at 100-150 mL/hour

====[[Calcitonin]]====
*Consider adding calcitonin 4 units/kg SC or IV q12hr in patients w/ Ca >14 mg/dL (3.5 mmol/L) who are also symptomatic (lowers Ca w/in 2-4hr)
*Tachyphylaxis limits use long term, but is a great choice for emergent cases

====Bisphosphonates====
Give for severe hypercalcemia due to excessive bone resorption (lowers Ca within 12-48hr)[≥12 mg/dL][≥3 mmol/L]<ref>Shane et al. Uptodate: Treatment of Hypercalcemia. https://www.uptodate.com/contents/treatment-of-hypercalcemia#disclaimerContent</ref>
*Pamidronate 90mg IV over 24 hours OR
*[[Zoledronate]] 4mg IV over 15 minutes
*Caution in renal failure, though bisphosphonates have been safely used in pts with pre-existing renal failure<ref>LeGrand SB et al. Narrative Review: Furosemide for Hypercalcemia: An Unproven yet Common Practice. Ann Intern Med. 2008;149:259-263.</ref>

====[[electrolyte repletion|Electrolyte Repletion]]====
*Correct [[hypokalemia]]
*Correct [[hypomagnesemia]]

====[[diuretics|Diuresis]]====
*[[Furosemide]] is NOT routinely recommended
*Only consider in patients with renal insufficiency or heart failure and volume overload

====[[Dialysis]]====
Consider if patient:
*Anuric with [[renal failure]]
*Failing all other therapy
*Severe [[fluid overload|hypervolemia]] not amenable to diuresis
*Serum Calcium level >18mg/dL
*Neurologic symptoms
*Heart failure with reduced ejection fraction (unable to provide fluids)

====[[Corticosteroids]]====
''Decrease Ca mobilization from bone and are helpful with steroid-sensitive tumors (e.g. lymphoma, MM)''
*[[Prednisone]] 60mg PO daily