Treatment depends on how severe the hypercalcemia is.

Hypercalcemia may be mild, moderate, or severe. Because hypercalcemia can be caused by cancer itself, treatment for hypercalcemia will depend on how well the cancer treatment is working.

Severe hypercalcemia should be treated right away. Less severe hypercalcemia is treated based on the symptoms. The treatment is working if the symptoms of hypercalcemia disappear and the level of calcium in the blood decreases.

Treatment that decreases the amount of calcium in the blood usually:

• Relieves symptoms.
• Makes pain easier to control.
• Improves quality of life.
• Allows you to leave the hospital sooner (for patients with moderate to severe hypercalcemia).

After calcium levels return to normal, urine and blood samples will be checked often to make sure the treatment is still working.

Mild hypercalcemia.

Patients with mild hypercalcemia may not have any symptoms and usually do not need agressive treatment. If you have no symptoms of hypercalcemia and your cancer responds well to anticancer treatment, treatment for hypercalcemia may include:

• Fluids.
• Observation (watching your condition but not giving treatment unless symptoms appear or change).

If you have symptoms of hypercalcemia or your cancer is not expected to respond quickly to treatment, treatment for the hypercalcemia may include the following:

• Drugs to lower the level of calcium in the blood.
• Drugs to control nausea, vomiting, and fever.
• Staying active.
• Limiting the use of drugs that cause sleepiness.

Moderate to severe hypercalcemia.

Treatment for moderate to severe hypercalcemia includes the following:

• Replace fluids.

  Replacing fluids is the first and most important step in treating moderate or severe hypercalcemia. This will not lower blood calcium to normal levels in all patients, but fluid replacement will improve symptoms such as confusion, nausea, and vomiting.

• Drugs to control hypercalcemia.

  If cancer treatment cannot be started right away, then drugs to lower the calcium levels are used to control the hypercalcemia. The following drugs help stop the breakdown of bone and the release of calcium into the blood:

  • Bisphosphonates.
  • Calcitonin.
  • Plicamycin (mithramycin).
  • Gallium nitrate.
  Steroids and phosphates may also be used to treat hypercalcemia. Other drugs are being studied.
• Begin dialysis treatment.

  Dialysis may be needed for patients with kidney failure.

Some patients may need medicine to manage confusion and other psychological symptoms.

Mental changes may take some time to get better, even after calcium levels return to normal. Usually, treatment of hypercalcemia will stop delirium, agitation, and mental changes, but some patients may need other medicines to treat these symptoms. (See the PDQ summary on Cognitive Disorders and Delirium for more information.)

Lethargy (feeling sluggish) is often a symptom of hypercalcemia. Family members (and sometimes medical staff) may think lethargy is depression until the actual cause is found. Most patients with lethargy will show little energy or interest in life. However, patients with lethargy will not have symptoms of depression (such as hopelessness, helplessness, guilt, worthlessness, or thoughts of suicide). It is important to know the difference between depression and lethargy so that the right treatment is given.

The decision to treat hypercalcemia depends on the treatment goals of the patient.

Hypercalcemia can make it hard to think clearly. Your choices about cancer care and treatment should be made when you are clearly able to decide for yourself. Untreated hypercalcemia will get worse and cause loss of consciousness and coma. Some patients who have advanced terminal cancer and are no longer getting treatment for the cancer may choose not to be treated for hypercalcemia.