What is a common initial treatment for hypercalcemia?

• A. Oral calcium supplements
• B. Normal saline infusion
• C. Dextrose infusion
• D. Bisphosphonates alone

Answer: (B)

The main idea is to rapidly correct volume depletion and promote calcium loss in the urine. Normal saline infusion is the initial treatment because giving isotonic fluids expands intravascular volume, improves renal perfusion and glomerular filtration rate, and increases calciuresis (calcium excretion in urine). This helps bring down calcium levels quickly and safely.

Oral calcium supplements would raise calcium rather than lower it. A dextrose infusion doesn’t address the calcium problem. Bisphosphonates, while important for longer-term control by inhibiting bone resorption, take longer to work and are not the first step in acute stabilization. After hydration, additional measures like loop diuretics to enhance calcium excretion or other targeted therapies can be considered as needed, but they don’t replace the need for initial IV fluids.