Initial management of hypercalcemia typically includes which of the following?

• A. IV fluids and furosemide
• B. Calcitonin alone
• C. Bisphosphonates alone
• D. Dialysis

Answer: (A)

The main idea is to start by correcting volume status and promoting calcium loss in the urine. Hypercalcemia often worsens with dehydration, so giving isotonic IV fluids expands circulating volume, improves renal perfusion, raises glomerular filtration, and increases calcium excretion. After hydration is established, a loop diuretic like furosemide can be used to enhance urinary calcium excretion, helping reduce serum calcium. This approach targets the immediate problem—excess calcium—without relying on slow-acting therapies.

Calcitonin can lower calcium quickly but modestly and for a short duration, and bisphosphonates lower calcium by inhibiting bone resorption but take longer to work, so they’re not initial measures. Dialysis is reserved for severe or refractory cases or when kidney function is poor.