Hypercalcemic crisis successfully treated with prompt calcium-free hemodialysis

Hypercalcemic crisis, a life-threatening emergency, is defined as decompensated hypercalcemia presented with characteristic symptoms such as oliguria, cardiac arrhythmia, or coma. We report the case of a 63-year-old man diagnosed with mucosa-associated lymphoid tissue lymphoma and multiple bony metastases, who presented to the emergency department (ED) with coma and severe hypercalcemia (4.15 mmol/L). Prompt hydration with normal saline and intravenous pamidronate failed to correct his hypercalcemic coma. Calcium-free hemodialysis rapidly decreased the level of serum total calcium to 2.15 mmol/L after a 2-hour session, and the patient dramatically regained consciousness shortly after hemodialysis. Calcium- free hemodialysis has proved favorable for rapidly correcting hypercalcemia in the presence of severe hypercalcemic symptoms, congestive heart failure, renal failure, or other conditions that contraindicate adequate hydration. This case highlights the fact that for all patients with comas of questionable cause in the ED, hypercalcemia- induced coma must be considered, especially in patients with malignancies. Early diagnosis and prompt treatment with calcium-free hemodialysis not only rapidly improve patient consciousness but also prevent the fatal complication of hypercalcemia.