[Severe hypercalcemia in intensive care medicine].

Area of Science:

• Endocrinology and Metabolism
• Nephrology
• Oncology

Context:

• Hypercalcemic crisis is a rare but life-threatening condition, often stemming from primary hyperparathyroidism or malignancy.
• Severe hypercalcemia (albumin-corrected total calcium > 3.5 mmol/L) with symptoms necessitates immediate intervention.
• Understanding the complex calcium regulation system is key to managing this endocrine emergency.

Purpose:

• To outline the diagnostic criteria and essential management strategies for hypercalcemic crisis.
• To emphasize the importance of rapid, symptomatic treatment alongside definitive calcium-lowering therapies.
• To highlight the role of parathyroid hormone (PTH) levels in differentiating causes and guiding treatment.

Summary:

• Initial management focuses on ABCDEs and fluid resuscitation, followed by controlled calcium reduction using diuretics, dialysis, calcitonin, or specific medications like bisphosphonates.
• Treatment strategies are tailored based on PTH levels (PTH-dependent vs. PTH-independent causes) and patient's volume status and comorbidities.
• Effective management involves addressing the underlying cause, such as primary hyperparathyroidism or malignancy, to improve long-term prognosis.

Impact:

• Timely and appropriate treatment of hypercalcemic crisis can significantly improve patient outcomes and survival rates.
• This condition underscores the critical need for prompt recognition and management protocols in emergency settings.
• Understanding the underlying pathophysiology aids in developing targeted therapies for severe hypercalcemia.