<prompt> Treatment of acute hypercalcemia-Normal saline with forced diuresis with chlohiazidePlicamycinGallium nitrateMithramycin  <response>: Hypercalcaemic Crisis It may be the mode of presentation in primary hyperparathyroidism especially in elderly. It presents with dehydration, hypotension, abdominal pain, vomiting, fever, altered sensorium. It is a medical emergency.Management Medical Management 1.Rehydration until serum calcium level falls 4-6 litres of normal saline in first 24 hrs 2.Correct electrolyte imbalance and give frusemide 100 mg 1-2 hours 3.Other methods to decrease serum calcium are: a.Salmon calcitonin 200-400 IU 8 hourly subcutaneously b.Mithramycin 25 ugkg IV c.Neutral phosphate IV 500 ml over 6-8 hrs 4.Avoid drugs like digoxin hypercalcaemia and hypocalcaemia may potentiate its toxicity, thiazides decrease the calcium excretion, vitamin A, D increase the bone turnover oestrogen and antioestrogen. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE 4TH EDITION PAGE NO - 631 