Thursday April 22, 2010


Question: What is the choice of diuretics in initial treatment of life threatening hypercalcemia?


Answer: Loop diuretics

The initial management in severe hypercalcemia is hydration with saline. Hydration helps decrease the calcium level through dilution. The expansion of extracellular volume also increases the renal calcium clearance - but vigilance to prevent volume overload is critical and may require diuretics with saline hydration. A loop diuretic (like furosemide) should be used with hydration to increase calcium excretion. This also prevents volume overload during therapy. Thiazide diuretics should be avoided because they increase the reabsorption of calcium.