title: Treatment of medically refractory hypercalcemic crisis.
abstract: BACKGROUND
  A 58-year-old patient was admitted to the intensive care unit for severe hypercalcemia (total Ca 5.30 mmol/L) complicated with status epilepticus, hypertensive crisis and acute renal failure. Renal replacement therapy was explored as a method for treating medically refractory hypercalcemia.
  
  
  METHODS
  Because of hemodynamic instability during intermittent hemodialysis (IHD), continuous venovenous hemofiltration (CVVH) with high rates of calcium-free replacement fluids was instituted. Epoprostenol rather than citrate was used as anticoagulation to ensure adequate extracorporeal anticoagulation.
  
  
  RESULTS
  CVVH was continued for 40 hours total during which ionized calcium decreased from 2.19 to 1.07 mmol/L. The etiology of the hypercalcemia was from autoinfarction of a parathyroid adenoma.
  
  
  CONCLUSIONS
  This is the first case of hypercalcemia treated with CVVH with epoprostenol anticoagulation. This method avoids some of the pitfalls of using intermittent hemodialysis. It is also a rare example of hypercalcemia induced posterior reversible encephalopathy syndrome (PRES).
authors.affiliation: Department of Critical Care Medicine, University of Calgary, Alberta, Canada. selena.au@gmail.com
authors.forename: Selena
authors.initials: S
authors.lastname: Au
authors.forename: Michael
authors.initials: M
authors.lastname: Dunham
authors.forename: Tomas
authors.initials: T
authors.lastname: Godinez
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000236:Adenoma / Q000098:blood supply / Q000150:complications* / Q000175:diagnosis; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D016638:Critical Illness; D011464:Epoprostenol / Q000627:therapeutic use; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D007238:Infarction / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000098:blood supply / Q000150:complications* / Q000175:diagnosis; D054038:Posterior Leukoencephalopathy Syndrome / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D011464:Epoprostenol; D002118:Calcium