Severe hypercalcaemia and colon ischaemia: dehydration as an unusual cause?

Autor:	Fernandes LG; Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Ferreira NR; Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Cardiga R; Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal., Póvoa P; Intensive Care Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
Jazyk:	angličtina
Zdroj:	BMJ case reports [BMJ Case Rep] 2015 Mar 25; Vol. 2015. Date of Electronic Publication: 2015 Mar 25.
DOI:	10.1136/bcr-2014-208809
Abstrakt:	Hypercalcaemia is an emergency with severe consequences. Dehydration can be an uncommon cause of hypercalcaemia, as seen in this case. A 63-year-old woman with type 2 diabetes mellitus, hypothyroidism and osteoporosis, was admitted to the emergency room with abdominal distension and vomiting for 24 h. Initial evaluation was Hg 18.5 g/dL, Htc 56.2%, creatinine 2 mg/dL, metabolic acidaemia, lactate 8.3 mmol/L, anion gap 19, total Ca(2+) 17.7 mg/dL and PO4+ 6.6 mg/dL. CT revealed colonic distension without obstruction or ischaemia. Renal replacement therapy and pamidronate were initiated. The patient's clinical condition deteriorated with septic shock in the context of toxic megacolon and she underwent an emergency subtotal colectomy (10 kg). Hypercalcaemia was corrected in 24 h with aggressive fluid replacement (8 L NaCl 0.9% first 12 h), with a reduction of total Ca(2+) to 8.2 mg/dL. Other causes of hypercalcaemia were excluded. 'Hypercalcaemic crisis' secondary to severe acute dehydration is not mentioned in the literature. (2015 BMJ Publishing Group Ltd.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu