Therapy

• fluid: 0.9% saline iv - at once ^d

Consider use of additional monitoring (such as central venous pressure and urinary catheter) in patients with critical fluid balance (e.g. severe cardiac failure or renal insufficiency)

• frusemide

Malignancy

Give 

• pamidronate ^a  90 mg over 1 hour intravenously ^a  
  
  • Alternatives include
    • gallium nitrate (200 mg/ m ² per day iv for 5 days) ^a  

Give steroids to patients with steroid-responsive malignancy (e.g. breast cancer, myeloma, renal cell carcinoma) ^a  

There is no clear role for

• calcitonin ^d  

Treat asymptomatic and mild cases conservatively.
Hormone replacement therapy may be beneficial in post-menopausal women. ^c  

Refer for parathyroidectomy in symptomatic cases. ^a