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The first step in the management of hypercalcemia is saline infusion. This approach is important because hypercalcemia can lead to dehydration due to the increased renal excretion of calcium. Administering intravenous saline helps to restore intravascular volume and promotes renal excretion of calcium by diluting serum calcium levels and increasing urinary calcium output. This is particularly effective in patients experiencing acute hypercalcemia, allowing for faster management of the condition.

Saline infusion also addresses any potential volume depletion that may be present in patients with hypercalcemia, further supporting renal function and facilitating the excretion process.

While diuretics might be used later in the management of hypercalcemia to enhance calcium elimination, they are not the first step, especially the loop diuretics, which have a more secondary role. Calcitonin therapy can be effective in lowering calcium levels, but it is typically used after initial hydration rather than as a first-line treatment. Therefore, beginning with saline infusion lays the crucial groundwork for subsequent management interventions.