What is the first step in the management of a patient presenting with hypercalcemia?

The initial management of a patient presenting with hypercalcemia predominantly involves aggressive intravenous (IV) fluids. This is crucial because dehydration can exacerbate hypercalcemia, and rehydrating the patient helps to dilute serum calcium levels. Administering IV fluids, particularly isotonic saline, promotes renal excretion of calcium and helps to manage the symptoms efficiently.

By increasing urine output through hydration, it aids in the clearance of calcium from the bloodstream, which is a critical first step before considering other treatments that may target the underlying cause of hypercalcemia, such as bisphosphonates or calcitonin.

Oral bisphosphonates and calcium supplements are inappropriate initial management strategies, as they could further increase the calcium levels in the body. Diuretics may be employed later to enhance calcium excretion, but they must be used in conjunction with adequate fluid replacement, making IV fluids the priority at the outset of treatment.