title: Hypercalcaemia and acute renal failure after major burns: An under-diagnosed condition.
abstract: BACKGROUND
  Hypercalcaemia has been shown to occur in about 20% of patients with major burns requiring prolonged intensive care unit (ICU) treatment, and it may be associated with renal failure. Having observed the early onset of hypercalcaemia, the study aimed to determine the frequency and timing of this condition in a European patient cohort.
  
  
  METHODS
  A retrospective cohort study on a prospectively collected, computerised database of the 225 burn-injury ICU admissions between 2001 and 2007 was undertaken. The inclusion criteria included: burns >20% of the body surface area (BSA) or in-hospital stay >20 days. Hypercalcaemia was defined as an ionised plasma calcium (Ca(2+)) concentration >1.32 mmol l(-1) (or total corrected calcium=[Ca]c>2.55 mmol l(-1)). Four emblematic cases are reported in this article.
  
  
  RESULTS
  A total of 73 patients met the inclusion criteria (age: 13-88 years, burns: 12-85% BSA): of these, 22 (30%) developed hypercalcaemia. The median time to the first hypercalcaemia value was 21 days. Only 11 patients had both high Ca(2+) and elevated [Ca]c (which remained normal in others). The risk factors of the disorder were burned surface (p=0.017) and immobilisation (fluidised bed use: p<0.05, duration: p=0.02) followed by burned BSA. Acute renal failure tended to be more frequent in hypercalcaemic patients (five (23%) vs. three (6%): p=0.11), while mortality was not increased. The disorder resolved with hydration and mobilisation in most cases: pamidronate was successful in three cases that were most severe.
  
  
  CONCLUSIONS
  Hypercalcaemia and associated acute renal failure occur more frequently and earlier than previously reported. Determining the ionised Ca rather than the total Ca with albumin correction enables earlier detection of hypercalcaemia. Bisphosphonates are an effective treatment option in controlling severe hypercalcaemia and preventing bone loss.
authors.affiliation: Department of Intensive Care Medicine & Burns Centre, University Hospital (CHUV), CH-1011 Lausanne, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kohut
authors.forename: Julien
authors.initials: J
authors.lastname: Rossat
authors.forename: Wassim
authors.initials: W
authors.lastname: Raffoul
authors.forename: Olivier
authors.initials: O
authors.lastname: Lamy
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications* / Q000473:pathology; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000209:etiology*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003404:Creatinine; D002118:Calcium