Stop calcium and vitamin D supplements
Stop thiazide diuretics and other contributing medications if possible
Assess severity, symptoms, and underlying cause
Give isotonic intravenous saline for volume repletion
Monitor urine output, electrolytes, and renal function
Use calcitonin for rapid short-term calcium lowering
Give intravenous bisphosphonates for malignancy-related hypercalcemia
Use denosumab if bisphosphonates are ineffective or contraindicated
Consider glucocorticoids for vitamin D–mediated hypercalcemia or certain malignancies
Use loop diuretics only after adequate hydration if needed for volume overload
Consider dialysis for severe, refractory, or life-threatening hypercalcemia
Treat the underlying cause definitively
Encourage mobilization when appropriate
Recheck serum calcium frequently during treatment