Treatment of medically refractory hypercalcemic crisis
Selena Au1, Michael Dunham, Tomas Godinez
1Department of Critical Care Medicine, University of Calgary, Alberta, Canada. selena.au@gmail.com
The International Journal of Artificial Organs
|April 6, 2012
Summary
Continuous venovenous hemofiltration (CVVH) effectively treated severe hypercalcemia and associated complications. This method, using epoprostenol anticoagulation, offers an alternative to intermittent hemodialysis for refractory cases.
Area of Science:
- Nephrology
- Intensive Care Medicine
- Endocrinology
Background:
- Severe hypercalcemia (total Ca 5.30 mmol/L) presented with status epilepticus, hypertensive crisis, and acute renal failure.
- Medically refractory hypercalcemia necessitated exploring advanced renal replacement therapy.
Observation:
- Hemodynamic instability during intermittent hemodialysis (IHD) prompted a switch to continuous venovenous hemofiltration (CVVH).
- CVVH utilized high-volume calcium-free replacement fluids and epoprostenol for anticoagulation.
Findings:
- CVVH was administered for 40 hours, successfully reducing ionized calcium from 2.19 to 1.07 mmol/L.
- The underlying cause of hypercalcemia was identified as autoinfarction of a parathyroid adenoma.
- The patient also experienced hypercalcemia-induced posterior reversible encephalopathy syndrome (PRES).
Implications:
- This case highlights CVVH with epoprostenol as a viable treatment for severe, refractory hypercalcemia, mitigating IHD-related complications.
- This approach offers a safer alternative for managing hypercalcemia-induced PRES and acute kidney injury.
- The study presents the first documented use of CVVH with epoprostenol for hypercalcemia treatment.
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