[Hypercalcemia as an emergency]

The hypercalcemic syndrome and the relation of serum calcium with the concentration of ionic calcium and albumin are shortly described. The pathogenetic significance of local, cytokine-induced bone destruction and of the osteoclast-stimulating effect by "parathyroid hormone related peptide" leading to "humoral hypercalcemia of malignancy" is underscored. In a hypercalcemic emergency the therapeutic strategy should combine adequate rehydration and induction of calciuresis by furosemide and the intravenous application of a rapid-onset, calcium lowering substance such as calcitonin and, simultaneously, of a slow-onset, long-acting bisphosphonate such as pamidromate, which may be infused as a single dose.