title: Hypercalcemic crisis resulting from near drowning in an indoor public bath.
abstract: METHODS
  Male, 66.
  
  
  METHODS
  Hypercalcemic crisis.
  
  
  METHODS
  Near drowning state.
  
  
  METHODS
  -
  
  
  METHODS
  -
  
  
  METHODS
  Critical care medicine.
  
  
  OBJECTIVE
  Challenging differential diagnosis.
  
  
  BACKGROUND
  Hypercalcemic crisis, generally caused by malignancy or primary hyperparathyroidism, is a life-threatening emergency that can result in multi-organ failure. Lowering the patient's calcium level immediately and determining the correct etiology are essential.
  
  
  METHODS
  We report a case of hypercalcemic crisis with a novel etiology. A 66-year-old male presented to the emergency room in cardiac arrest with a ventricular arrhythmia after being discovered submerged in an indoor public bath. He underwent cardioversion and was emergently intubated. Computed tomography showed bilateral pulmonary edema, suspected from water aspiration. Laboratory data revealed severe hypercalcemia and mild hypernatremia. Following three days of continuous hemodiafiltration, serum Ca decreased to and remained within normal limits. We concluded the etiology of hypercalcemia was absorption of Ca resulting from aspirated water.
  
  
  CONCLUSIONS
  Near drowning can be a cause of hypercalcemic crisis. For cases of near drowning, it is important to investigate the source of the aspirated water and consider electrolyte abnormalities in the diagnosis.
authors.affiliation: Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
authors.forename: Ryusaku
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Go
authors.initials: G
authors.lastname: Yamada
authors.forename: Aya
authors.initials: A
authors.lastname: Amano
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yamada
authors.forename: Keita
authors.initials: K
authors.lastname: Hamamatsu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Murabe
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yokota
keywords: emergency; hot springs; hypercalcemia; near-drowning