title: A case of hypercalcemia and gastric necrosis from hot pack ingestion.
abstract: Hot packs (instant hot compresses) are frequently used to relieve pain. We report a patient who had significant complications from ingestion of a hot pack containing calcium salts. A 35-year-old male swallowed three hot packs, and developed hematemesis, severe abdominal pain, and hypercalcemia (21.1 mg/dl). He developed diffuse gastric necrosis requiring gastrectomy and colonic interposition. Hypercalcemia was treated with intravenous fluids, pamidronate, and calcitonin. A Medline search revealed no prior report on hot pack ingestion though ingestion of calcium salts has been reported. Hot packs can potentially cause significant injury both from an exothermic reaction and hypercalcemia. Ingestions of calcium salts can result in necrosis of the stomach. Management includes aggressive treatment of hypercalcemia, supportive care and upper gastrointestinal endoscopy.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, Kosair Children's Hospital, University of Louisville, Louisville, KY 40202, USA. p0padm01@gwise.louisville.edu
authors.forename: Pradeep
authors.initials: P
authors.lastname: Padmanabhan
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.forename: George M
authors.initials: GM
authors.lastname: Bosse
mesh_terms: D000328:Adult; D001772:Blood Cell Count; D002057:Burns, Chemical / Q000473:pathology / Q000628:therapy*; D004338:Drug Combinations; D005440:Fluid Therapy; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D006934:Hypercalcemia / Q000139:chemically induced*; D008297:Male; D009336:Necrosis; D010146:Pain / Q000209:etiology; D010289:Parenteral Nutrition, Total; D011329:Prisoners; D013272:Stomach Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D013406:Suicide, Attempted
chemical_list: D004338:Drug Combinations