Hypercalcaemia of malignancy is considered a palliative emergency. It is the commonest life-threatening metabolic disorder associated with cancer and occurs in about 10–20% of all patients with malignant disease (Ravichandran, 2010). Hypercalcaemia of malignancy is usually progressive, causes unpleasant symptoms, can cause patients to deteriorate rapidly and may be the cause of death in patients who are either not treated or where the hypercalcaemia is refractory to treatment. Most patients with hypercalcaemia of malignancy have disseminated advanced disease and 80% die within 1 year with a median survival of 3–4 months.

Hypercalcaemia is a condition in which there is excessive calcium in the bloodstream. The normal range of serum calcium in adults is 2.2–2.6 mmol/L (9–10.5 mg/dL) (Box 17.3). Where total plasma calcium is measured, both protein bound and unbound ionised calcium are measured. To correct for hypoalbuminaemic states, use the formula: