title: Severe hypercalcaemia and colon ischaemia: dehydration as an unusual cause?
abstract: 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.
authors: Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors: Liliana Gil
authors: LG
authors: Fernandes
authors: Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors: Nuno Ribeiro
authors: NR
authors: Ferreira
authors: Medicine Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors: Rosa
authors: R
authors: Cardiga
authors: Intensive Care Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors: Pedro
authors: P
authors: Póvoa
mesh_terms: D002118:Calcium / Q000097:blood*; D017091:Colitis, Ischemic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003404:Creatinine / Q000097:blood; D003681:Dehydration / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D007362:Intensive Care Units; D007902:Length of Stay; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D003404:Creatinine; D002118:Calcium