[Hypercalcemic crisis in intensive care]

Area of Science:

• Endocrinology
• Nephrology
• Oncology

Context:

• Hypercalcemic crisis is a life-threatening condition characterized by severe hypercalcemia and multiorgan failure.
• Untreated, it carries a high mortality rate, necessitating urgent diagnostic and therapeutic measures.
• Rapidly rising calcium levels significantly impair nervous, renal, cardiovascular, and gastrointestinal systems.

Purpose:

• To outline the causes, clinical presentation, and management strategies for hypercalcemic crisis.
• To emphasize the critical need for prompt intervention in managing severe hypercalcemia.
• To discuss both causal treatments and supportive therapies for hypercalcemic crisis.

Summary:

• Hypercalcemic crisis, often caused by malignancy or primary hyperparathyroidism, presents with diverse organ system dysfunction.
• Treatment involves addressing the underlying cause (e.g., malignancy treatment, surgery for hyperparathyroidism) and supportive care to lower calcium levels.
• Key supportive therapies include rehydration with normal saline, bisphosphonates, loop diuretics, calcitonin, steroids, and calcimimetics. Continuous renal replacement therapy offers an alternative for acute calcium reduction.

Impact:

• Highlights the critical nature of hypercalcemic crisis and the importance of timely intervention.
• Provides a comprehensive overview of current and emerging therapeutic approaches.
• Aids clinicians in the rapid diagnosis and management of this severe endocrine emergency.