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Epidemiology, clinical features, and management of severe hypercalcemia in critically ill patients

Cyril Mousseaux1, Axelle Dupont2, Cédric Rafat3

  • 1Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris Diderot University, Paris, France. mousseaux.cyril@gmail.com.

Annals of Intensive Care
|November 29, 2019
PubMed

Insights

Severe hypercalcemia (HCM) is a serious condition often requiring intensive care. Prompt management, particularly with bisphosphonates, and early ICU admission are crucial for improving outcomes in HCM patients, especially those with solid tumors.

Area of Science:

  • Intensive Care Medicine
  • Nephrology
  • Endocrinology

Background:

  • Severe hypercalcemia (HCM) is a frequent reason for intensive care unit (ICU) admission.
  • HCM can lead to significant morbidity and mortality, necessitating a thorough understanding of its clinical features, causes, and management.

Purpose of the Study:

  • To describe the clinical and biological characteristics of severe HCM.
  • To identify the etiologies, treatments, and outcomes of patients admitted to the ICU with severe HCM.

Main Methods:

  • A retrospective case series analysis of patients admitted to two ICUs between January 2007 and February 2017.
  • Inclusion criteria: total calcemia > 12 mg/dL (3 mmol/L).
  • Data collected included clinical and biological features, etiologies, treatments, and outcomes.

Main Results:

  • 131 patients with severe HCM were included.
  • Hematologic malignancy (44.3%) and solid tumors (22.1%) were the most common causes.
  • 82.4% of patients developed acute kidney injury (AKI), and 19% required renal replacement therapy (RRT).
  • Bisphosphonate use was significantly associated with decreased calcemia at day 5.
  • ICU and hospital mortality rates were 9.9% and 21.3%, respectively.
  • Simplified Acute Physiologic Score (SAPS II) and underlying solid tumors were independent predictors of hospital mortality.

Conclusions:

  • Severe HCM is associated with high mortality, primarily driven by underlying malignancies.
  • Organ failures, such as AKI, are common but often reversible with early ICU intervention.
  • Early ICU admission and prompt management are critical for improving survival, especially in patients with solid tumors and neurological symptoms.
Abstract

Keywords:
AKI etiologyAcute kidney injury (AKI)Hypercalcemia (HCM)Kidney disease outcomeMortalityOnco-hematologyPrognosisRenal replacement therapy (RRT)

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