Hypercalcemia in patients with type 2 intestinal failure receiving parenteral support: A descriptive cohort study

Patients with type 2 intestinal failure (IF) are metabolically unstable and prone to electrolyte derangements. Nevertheless, the data on the prevalence of hypercalcemia in these patients are lacking to date. The aim of this study was therefore to evaluate the prevalence and causes of hypercalcemia in patients with type 2 IF during their first admission to a dedicated IF unit.

This was a cohort study of patients with a new diagnosis of type 2 IF admitted to a national UK IF Reference Centre between July 1, 2018, and April 31, 2023. Patients with identified hypercalcemia were followed up from their admission until parenteral support cessation or end of the follow-up on December 31, 2024.

Overall, there were 265 patients included in the analysis. In total, 26/265 (9.8%) patients were diagnosed with hypercalcemia during the admission. In most patients, the cause of hypercalcemia was multifactorial with immobilization, dehydration, and presence of calcium in parenteral support being the most common factors. In all cases, hypercalcemia was transient and resolved by the end of patient admission with continuous optimization of hydration, reduction in supplemented calcium, and/or improved patient mobility. Notably, 11/26 (45.8%) patients with transient inpatient hypercalcemia remained on calcium-free parenteral support after hospital discharge.

Hypercalcemia is present in almost 10% of all admissions with type 2 IF and is multifactorial in origin. Care should be undertaken to optimize patient hydration, parenteral support prescription, and mobilization in the acute hospital setting, with ongoing assessment of calcium requirements following discharge.