Sx:Fatigue, weakness, sleepiness, nausea/anorexia, constipation, polyuria/dypsia, and volume depletion
Si:Confusion, delirium, drowsiness, coma
Pancreatitis, increased risk of digoxin toxicity
Lab:
Chem:Calcium elevated (Calcium Level, Corrections in Serum for corrections for low proteins) 
10.5 mg %; sx usually between 11-12 mg %, really toxic over 14 mg %
Noninv:EKG, Short QT interval w normal T wave, segment from QRS to beginning of T shortened
Rx:
Acute rx for Ca++ >13 mg %, to decrease within hours:
- Normal saline 2.5-4 L/24 h iv to assure intravascular volume adequately replaced (CVP or Swann monitoring), avoid furosemide (Nejm 1984;310:1718) initially, but often needed after volume replaced to prevent volume overload and accelerate renal calcium clearance
- Pamidronate (Aredia) 60-90 mg iv over 24 h (Med Let 1992;34:1), or 4-8 mg/h
Chronic rx, work over 1-5 d, worth doing even with metastatic cancer since diminishes sx and allows hospital discharge (Ann IM 1990;112:499):
- Biphosphonates, eg, pamidronate (Aredia) 60-90 mg iv infusion over 8-24 h (Med Let 1992;34:1) or 1200 mg po qd × 5 d
- Steroids (Ann IM 1980;93:269, 449) primarily for sarcoid pts, eg, prednisone 20 mg po tid
- Calcitonin 4 U/kg q 6 h sc or im, relatively weak agent alone
- Indomethacin (rarely helpful if due to cancer)
- Gallium nitrate iv infusion, experimental (Med Let 1991;33:41; Ann IM 1988;108:669) 200 mg/m2 in 1 L continuous infusion qd × 5 d