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Hypercalcemia in critically ill surgical patients.

J Forster, L Querusio, K W Burchard

Annals of Surgery

|October 1, 1985

Summary

Approximately 15% of critically ill surgical patients develop hypercalcemia. This condition is linked to factors like renal failure, prolonged total parenteral nutrition, and multiple transfusions, potentially indicating a new form of hyperparathyroidism.

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Area of Science:

Critical care medicine
Endocrinology
Surgical pathology

Background:

Critical surgical illness often presents with hypocalcemia, but hypercalcemia can occur.
A study reviewed 100 patients with extended stays in a surgical intensive care unit (SICU) to investigate hypercalcemia incidence.

Observation:

15% of patients (15 out of 100) exhibited elevated ionized calcium levels.
Hypercalcemic patients had higher frequencies of renal failure, dialysis, prolonged total parenteral nutrition (TPN), bacteremia, massive transfusions, and shock.
This group also experienced more early hypocalcemia episodes.

Findings:

Elevated parathormone (PTH) levels were observed in hypercalcemic patients, even without malignancy or other common causes.
Renal failure and hypocalcemia may stimulate PTH secretion, but hypercalcemia occurred in patients without renal failure.

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The findings suggest a potential new form of hyperparathyroidism in critically ill surgical patients.

Implications:

Recognizing hypercalcemia in SICU patients is crucial for appropriate management.
Further research is needed to elucidate the exact mechanisms and long-term consequences of this condition.
This study highlights the complex metabolic disturbances in critically ill surgical populations.