Pamidronate for Hypercalcemia in Critically Ill Surgical Patients
Lisa Hall Zimmerman1, Heather S Dolman2,3, Lauren Riley Howell4
1Department of Pharmaceutical Services, William Beaumont University Hospital, Royal Oak, USA.
Introduction:
Hypercalcemia in critically ill patients is associated with an increased severity of illness and mortality that becomes worse as the levels rise. Pamidronate was evaluated for the treatment of hypercalcemia in critically ill surgical patients.
Methods:
This retrospective study evaluated 30 critically ill surgical patients who developed hypercalcemia (ionized calcium (iCa)≥1.25 mmol/L) while in the surgical ICUs over three years. Patients were case-matched 1:1 for age and severity of illness.
Results:
In the 30 patients with an overall Acute Physiology and Chronic Health Evaluation (APACHE) II of 22±9, mechanical ventilation was required in 27/30 (90%) and hemodialysis in 11/30 (37%). Within four days of pamidronate, iCa declined from a mean of 1.46±0.14 to 1.15±0.14 mmol/L, p=0.004; however, the blood urea nitrogen (BUN) and serum creatinine (SCr) increased significantly in patients with renal impairment. An iCa≥1.35 mmol/L increased mortality from 0% to 26%.
Conclusions:
Hypercalcemia in critically ill surgical patients is associated with increased severity of illness. Over a period of four days, pamidronate reduced iCa levels at ~0.08 mmol/L/day and corrected 80% of the hypercalcemic patients; however, it may cause further renal dysfunction.
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