Intensivmedizin und Notfallmedizin

, Volume 41, Issue 6, pp 406–416 | Cite as

Die hyperkalzämische Krise

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Zusammenfassung

Als hyperkalzämische Krise bezeichnet man ein akut lebensbedrohliches Krankheitsbild, das auf dem Boden einer dekompensierten Hyperkalzämie entsteht. Die Hyperkalzämie ist kein eigenständiges Krankheitsbild, sondern immer ein Symptom einer Grunderkrankung. Die Tumorhyperkalzämie (ca. 60–70%) und der primäre Hyperparathyreoidismus (ca. 20%) sind im stationären Bereich die häufigsten Ursachen; seltener sind iatrogene, entzündliche und sonstige endokrin bedingte Hyperkalzämien. Drei verschiedene pathogenetische Grundprinzipien können zu erhöhtem Serumkalzium führen: vermehrte enterale Aufnahme, vermehrter Knochenabbau und verminderte renale Kalziumausscheidung. Kennzeichnend für eine schwere akute Hyperkalzämie ist das gemeinsame Auftreten von gastrointestinalen, renalen, kardialen und neuropsychiatrischen/neuromuskulären Symptomen. Nach Verifizierung des tatsächlichen Vorliegens einer echten Hyperkalzämie (Albuminkorrektur) und ggf. Einleitung der notwendigen akutmedizinischen Maßnahmen (s. u.) ist zur Planung der weiteren Therapie die Diagnose der Grunderkrankung nötig. Für die symptomatische Therapie der Hyperkalzämie gibt es verschiedene Ansatzpunkte: Erhöhung der Kalzium- Ausscheidung, Hemmung der Kalziumfreisetzung und Hemmung der Kalzium-Absorption. An erster Stelle steht hierbei die Volumensubstitution und die kalziumarme Ernährung. Weitere Maßnahmen sind die Gabe von Diuretika, Kalzitonin und Bisphosphonaten. Bei Patienten mit granulomatösen Erkrankungen kann durch die Gabe von Glukokortikoiden eine Senkung des Kalziumspiegels erreicht werden. Liegt ein akutes oder chronisches Nierenversagen vor, oder konnte durch die o. g. Maßnahme keine suffiziente Senkung des Kalziumspiegels erreicht werden, kann die Hämodialyse eine schnelle Senkung des Serumkalziums erzielen.

Schlüsselwörter

Hyperkalzämie Hyperkalzämische Krise Hyperparathyreoidismus Bisphosphonate Kalzitonin 

Hypercalcemic crisis

Summary

The term hypercalcemic crisis refers to an acute, lifethreatening decompensation of preexisting hypercalcemia. Hypercalcemia itself must always be interpreted as a sign of an underlying disease. The most common causes in in-patients are hypercalcemia of malignancy (60–70%) and primary hyperparathyroidism (20%), whereas hypercalcemia originating from iatrogenic, inflammatory and other endocrine causes is rare. Increased enteral calcium absorption, increased bone resorption and decreased renal calcium excretion are three major pathogenetic mechanisms. The coincidence of gastrointestinal, renal, cardial and neuropsychiatric/neuromuscular symptoms is typical for acute severe hypercalcemia. The diagnosis can readily be established from the (albumin corrected) serum calcium levels, but detailed investigations are needed to uncover and treat the underlying cause. The basic principles of acute symptomatic therapy include fluid substitution and reduced calcium intake as well as the application of diuretics, calcitonin and bisphosphonates. Hypercalcemia of granulomatous disease may respond to glucocorticoid therapy. In patients with renal failure or lifethreatening hypercalcemia hemodialysis is an effective means to definitely lower calcium levels.

Key words

Hypercalcemia hypercalcemic crisis hyperparathyroidism calcitonin bisphosphonates 
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Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Innere Medizin IKlinikum der Universität RegensburgRegensburgGermany

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