Skip to main content

Calcium free hemodialysis: an effective therapy in hypercalcemic crisis — report of 4 cases

Intensive Care Medicine volume 15, pages 471–474 (1989)Cite this article

Abstract

Hypercalcemic crisis respresents a medical emergency. If conservative treatment is ineffective, low calcium bath or zero calcium bath hemodialysis are good alternatives. We report 4 patients treated with calcium free acetate hemodialysis because of hypercalcemic crisis due to breast cancer, hepatocellular carcinoma, cirrhosis of the liver and immobilisation with hydrochlorothiazids' medication. Following 3 h of hemodialysis, serum calcium concentrations fell from a mean value of 3.96 (range 3.53–4.46) mmol/l to 2.71 (2.28–3.12) mmol/l. In 2 patients rapid clinical improvement was achieved and in one oliguric patient diuresis started spontaneously during hemodialysis. One patient died from gram-negative sepsis. In 3 cases the subsequent conservative treatment was sufficient to maintain serum calcium levels within the normal range. Together with the previously reported cases (5 patients treated by hemodialysis with low dialysate calcium and 3 patients by hemodialysis with calcium free dialysate) our experience indicates that hemodialysis is an effective and safe therapy for hypercalcemic crisis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Suki WN, Yium JJ, Minden M van, Saller-Hebert C, Eknoyan G, Martinez-Maldonado M (1970) Acute treatment of hypercalcemia with furosemide. N Engl J Med 283:836–840

    Google Scholar 

  2. Binstock ML, Mundy GR (1980) Effect of calcitonin and glucocorticoids in combination on the hypercalcemia of malignancy. Ann Intern Med 93:269–272

    Google Scholar 

  3. Fillastre JP, Maitrot J, Cannonne MA, Gray CJ, Bastit P, Bourgeois T (1970) Renal function and alterations in plasma electrolyte levels in normocalcemic and hypercalcemic patients with malignant disease given an intravenous infusion of mithramycin. Chemotherapy 20:280–284

    Google Scholar 

  4. Paterson AD, Kanis JA, Cameron C, Douglas DL, Beard DJ (1983) The use of dichlormethylen diphosphonate for the management of hypercalcemia in multiple myeloma. Br J Haematol 54:121–132

    Google Scholar 

  5. Percival RC, Paterson AD, Yates AJP, Beard DJ, Douglas DL, Neal FE, Russell RGG, Kanis JA (1985) Treatment of malignant hypercalcemia with clodronate. Br J Cancer 51:665–669

    Google Scholar 

  6. Shane E, Jacobs TP, Siris ES, Steinberg SF, Stoddart A, Canfield Re, Bilezikiar JB (1982) Therapy of hypercalcemia due to parathyroid carcinoma with intravenous diphosphonate. Am J Med 72:939–944

    Google Scholar 

  7. Jamieson MJ (1985) Hypercalcemia. Br Med J 290:378–383

    Google Scholar 

  8. Goldsmith RJ, Sidney H, Ingbar H (1966) Inorganic phosphate treatment of hypercalcemia of diverse etiology. N Engl J Med 274:1–7

    Google Scholar 

  9. Dudley FJ, Blackburn CRB (1970) Extraskeletal calcification complicating oral neural phosphate therapy. Lancet II:628–630

    Google Scholar 

  10. Boen PT (1964) Peritoneal dialysis in clinical medicine, American Lecture Series. CC Thomas, Springfield, p 36

    Google Scholar 

  11. Hamilton JW, Lasrich M, Hirszel P (1980) Peritoneal dialysis in the treatment of severe hypercalcemia. J Dial 4:129–138

    Google Scholar 

  12. Heyburn PJ, Selby PL, Peacock M, Sandler LR, Pearson FM (1980) Peritoneal dialysis in the treatment of severe hypercalcemia. Br Med J 280:525–526

    Google Scholar 

  13. Lemann J, Donatelli AA (1964) Calcium intoxication due to primary hyperparathyroidism. Ann Intern Med 60:447

    Google Scholar 

  14. Leroy J, Robert M, Fillastre JP, Humbert G, Hemet J (1973) Crises hypercalcemiques aigues d'origine parathyroidienne. Sem Hop Paris 49:487–493

    Google Scholar 

  15. Maxwell MH, Rockney RE, Kleemann CR, Twiss MR (1959) Peritoneal dialysis I. Techniques and applications. J Am Med Assoc 170:917

    Google Scholar 

  16. Miach PJ, Dawborn JK, Moon WJ (1975) Management of the hypercalcemia of malignancy by peritoneal dialysis. Med J Aust 1:782–784

    Google Scholar 

  17. Nolph KD, Stoltz M, Maher JF (1971) Calcium free peritoneal dialysis: Treatment of vitamin D intoxication. Arch Intern Med 128:809–814

    Google Scholar 

  18. Raphael JC, Kleinknecht D, Chanard J, Jungers P (1971) L'hypercalcemie aigue néoplasique avec insuffisance rénale, Possibilités et limites du traitement par épuration extra-rénale. Presse Med 79:1103–1106

    Google Scholar 

  19. Cardella CJ, Birkin BL, Roscoe M, Rapaport A (1979) Role of dialysis in the treatment of severe hypercalcemia: report of two cases successfully treated with hemodialysis and review of the literature. Clin Nephrol 6:285–290

    Google Scholar 

  20. Eisenberg E, Gotch FA (1968) Normocalcemic hyperparathyroidism culminating in hypercalcemic crisis. Treatment with hemodialysis. Arch Intern Med 122:258–264

    Google Scholar 

  21. Strauch BS, Ball MF (1976) Hemodialysis in the treatment of hypercalcemia. J Am Assoc 235:1347–1348

    Google Scholar 

  22. Leow H, Wagner H (1973) Über den Wert der Hämodialysetherapie der hyperkalzämischen Krise bei primärem Hyperparathyreoidismus. Verh Dtsch Ges Inn Med 79:741

    Google Scholar 

  23. Chaves CM (1970) Parathyroid adenoma. South Med J 63:1167

    Google Scholar 

  24. Gerhardt A, Greenberg A, Reilly JJ, Theil DH van (1987) Hypercalcemia — a complication of advanced chronic liver disease. Arch Intern Med 147:274–277

    Google Scholar 

Download references

Author information

Affiliations

  1. Second Medical Department, General Hospital Linz, Austria

    W. Kaiser, G. Biesenbach & J. Zazgornik

  2. Third Medical Department, Hospital Wels, Austria

    R. Kramar

Authors
  1. W. Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Biesenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Kramar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Zazgornik
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kaiser, W., Biesenbach, G., Kramar, R. et al. Calcium free hemodialysis: an effective therapy in hypercalcemic crisis — report of 4 cases. Intensive Care Med 15, 471–474 (1989). https://doi.org/10.1007/BF00255605

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00255605

Key words

  • Hypercalcemia
  • Hemodialysis
  • Calcium free dialysate