SummaryThe management of severe life-threatening hypercalcemiain malignancy should start with intravenous fluid replacement; frusemide can be associated under scrupulous monitoring of fluid balance and electrolytes. Mithramycin is an efficacious adjuvant therapy, provided it is possible to wait 24 to 36 hours for mithramycin to become effective. Parenteral diphosphonates may prove to be useful in the control of malignant hypercalcemia, even in lifethreatening hypercalcemia.Calcitonin or corticosteroids on their own cannot be recommanded, though the combination deserves further assessment. Dialysis should be reserved for cases with marked renal impairment.Inmoderate hypercalcemiaonly two oral drugs are likely to be of significant help, corticosteroids or phosphates. The latter are more effective, but less acceptable to the patient. Increased fluid intake is an essential part of therapy. The next best therapy at present is intermittent, intravenous mithramycin at approximately one-week intervals. Some diphosphonates can be given orally, although the gastrointestinal absorption is variable.