Hypercalcaemia

Hypercalcaemia is common in advanced cancer particularly breast cancer, lung cancer and myeloma. 

  • Mild hypercalcaemia is an adjusted serum calcium of greater than 2.6 but less than 3.00 mmol/L
  • Moderate hypercalcaemia is an adjusted serum calcium of 3 to 3.5 mmol/L
  • Severe hypercalcaemia is an adjusted serum calcium of greater than 3.5 mmol/L
Red Flags
  • Serum adjusted calcium >3.0 mmol/L
  • Onset of confusion or reduced consciousness
  • Severe dehydration or acute kidney injury
  • Active treatment is appropriate
Clinical Features

Symptoms often mimic those of advanced illness:

Initial Approach to Treatment in the community
  • Check adjusted serum calcium
  • Review current medications (e.g. thiazides, calcium/vitamin D supplements)
  • Discuss ceiling of care with patient/family as definitive treatment requires hospital admission
  • Hydration: Encourage oral fluids, consider subcutaneous fluids if possible at home
  • Steroids (e.g. dexamethasone 8mg) may be helpul in certain malignancies (e.g. lymphoma, myeloma)
  • Symptom control: Antiemetics, laxatives, and delirium management as needed
Specialist input from secondary care/ inpatient palliative care

If condition is deteriorating despite above measures and active treatment is appropriate

Bisphosphonates (e.g., IV zoledronic acid or pamidronate) are usually effective in reducing calcium in malignancy-related hypercalcaemia

Denosumab – via oncologists

When Not to Treat

In patients nearing end of life where symptoms are mild or treatment burden outweighs benefit, it may be appropriate to focus solely on comfort

 

Recommended Resources

Scottish Palliative Care Guidelines - Hypercalcaemia

Published 1st May 2025

NICE CKS - Hypercalcaemia

Published 1st September 2024

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