Pamidronate for Hypercalcemia in Critically Ill Surgical Patients

Area of Science:

• Critical Care Medicine
• Nephrology
• Pharmacology

Background:

• Hypercalcemia in critically ill patients correlates with increased illness severity and mortality.
• This study investigated pamidronate for treating hypercalcemia in surgical ICU patients.

Purpose of the Study:

• To evaluate the efficacy and safety of pamidronate in treating hypercalcemia in critically ill surgical patients.
• To assess the impact of pamidronate on ionized calcium (iCa) levels and renal function.

Main Methods:

• Retrospective analysis of 30 critically ill surgical patients with hypercalcemia (iCa ≥ 1.25 mmol/L).
• Patients were case-matched 1:1 for age and severity of illness (APACHE II score).
• Treatment involved pamidronate, with outcomes assessed over four days.

Main Results:

• Pamidronate reduced mean iCa from 1.46 to 1.15 mmol/L within four days (p=0.004).
• Significant increases in blood urea nitrogen (BUN) and serum creatinine (SCr) were observed in patients with renal impairment.
• Mortality increased from 0% to 26% in patients with initial iCa ≥ 1.35 mmol/L.

Conclusions:

• Pamidronate effectively lowers iCa levels in critically ill surgical patients, correcting hypercalcemia in 80% of cases.
• The treatment may lead to further renal dysfunction, necessitating careful monitoring.
• Hypercalcemia severity is linked to increased illness severity and mortality in this population.