Which is the first-line treatment for severe symptomatic hypercalcemia?

The first-line treatment for severe symptomatic hypercalcemia is the administration of intravenous normal saline. This approach is effective because it helps to restore volume status, promote renal excretion of calcium, and dilute serum calcium levels. By providing IV fluids, the kidneys can increase calcium clearance through urine, effectively lowering serum calcium concentrations and alleviating symptoms associated with hypercalcemia, such as nausea, vomiting, and confusion.

Hydration contributes to the overall management strategy for hypercalcemia and is a critical initial step before more specific treatments are initiated, such as bisphosphonates or calcitonin, which may be used subsequently for their additional mechanisms in reducing calcium levels. However, normal saline serves as the foundational intervention in this acute scenario, making it the primary choice in cases of severe symptoms.