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Unusual presentation of more common disease/injury
CASE REPORT
Treatment of extreme hypercalcaemia: the role of haemodialysis
  1. Anna B. Basok,
  2. Boris Rogachev,
  3. Yosef Shmuel Haviv,
  4. Marina Vorobiov
  1. Department of Nephrology, Soroka University Medical Center, Beer Sheva, Israel
  1. Correspondence to Dr Anna B. Basok, basok{at}bgu.ac.il

Summary

A patient with extremely high calcium level of 23.9 mg/dL (5.97 mmol/L) was admitted to our department unconscious with pathological ECG recording, demonstrating shortening of QT interval. The patient was treated by fluid resuscitation, bisphosphonates, salmon calcitonin and steroids. Haemodialysis with low calcium bath had been promptly provided with improvement of consciousness and calcium level. ECG changes disappeared. Subsequent investigations revealed hyperparathyroidism and a large parathyroid adenoma was then surgically removed. Extreme and rapid calcium elevation (parathyroid crisis) is rarely seen in primary hyperparathyroidism and usually is distinctive for malignancy. In the context of acute kidney injury and refractory hypercalcaemia with life-threatening complications (coma, ECG changes with impending danger of arrhythmia), haemodialysis may effectively decrease calcium levels. It should be pointed out that dialysis is an efficient method of treatment of refractory hypercalcaemia, parathyroid crisis, but it is rarely used due to its invasive nature.

  • calcium and bone
  • fluid electrolyte and acid-base disturbances
  • arrhythmias
  • dialysis
  • acute renal failure

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2017-223772

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    Footnotes

    • Contributors AAB: treated the patient on admission, with case management, idea of article, writing the manuscript and review of literature. BR: participated in patient’s management. YSH: participated in writing and editing of the manuscript. MV: patient management and treatment decisions, writing the manuscript and data collection.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.