What is the first-line treatment for moderate hypercalcemia?

The first-line treatment for moderate hypercalcemia involves intravenous hydration and loop diuretics. This approach is crucial because it addresses both the immediate symptoms and helps reduce serum calcium levels. Intravenous hydration aids in enhancing renal excretion of calcium, thereby reducing the concentration of calcium in the bloodstream. Loop diuretics, such as furosemide, promote further calcium excretion by inhibiting reabsorption in the renal tubules, which is essential when significant urinary calcium excretion is needed.

While hydration alone can help, the addition of loop diuretics is particularly effective in cases of moderate hypercalcemia, where rapid intervention is necessary to alleviate potential complications such as dehydration, renal impairment, and related symptoms. This strategy ensures a more effective and rapid management of hypercalcemia compared to other treatments.

Other options, like bisphosphonates and calcitonin, are also used to manage hypercalcemia but typically come into play when initial medical management with hydration and diuretics is insufficient or when the hypercalcemia is due to malignancy. Therefore, they are considered subsequent lines of treatment rather than the first step in managing moderate hypercalcemia.