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Abstract: FR-PO597

Hypercalcemia in ESRD Patients Secondary to Immobilization: A Case Series

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Gupta, Sanjeev, Westchester county medical center, White Plains, New York, United States
  • Al Azzi, Yorg, Westchester county medical center, White Plains, New York, United States
Introduction

Immobilization is a well-known cause of hypercalcemia. However, there is scarce data available about hypercalcemia secondary to immobilization in end-stage renal disease (ESRD) patients as ESRD is often associated with hypocalcemia. We are presenting 3 cases of hypercalcemia in ESRD patients due to prolonged immobilization.

Case Description

1: A 59-year-old man with the history of diabetes mellitus admitted for liver and heart transplant. Hospital course was complicated by sepsis, ventilator dependent respiratory failure (VDRF) and renal failure requiring hemodialysis (HD). He was initially hypocalcemic with elevated PTH and calcitriol was started. However, later he developed hypercalcemia with highest serum calcium level being 12.7mg/dl. Calcitriol was withheld and low calcium bath was used but hypercalcemia didn’t resolve. Work-up came back negative [PTH-28 pg/ml, 25(OH)D-7 pg/ml and 1,25(OH)2 D-22 pg/ml].

2: A 61-year-old man with the history of CHF and ESRD secondary to polycystic kidney disease on HD admitted with pericardial effusion. Hospital stay was complicated by hemothorax and VDRF. A few months later he became hypercalcemic with calcium level elevated up to 11.6 mg/dl. Work-up was negative [PTH-28 pg/ml, 25(OH)D-44 pg/ml and 1,25(OH)2 D-40 pg/ml].

3: A 59-year-old lady with the history of atrial fibrillation, dilated cardiomyopathy, chronic heart failure and CKD admitted with CHF exacerbation. Hospital course was complicated by V. fibrillation arrest requiring AICD, renal failure requiring HD and VDRF. The patient remained ventilator dependent and developed hypercalcemia with a serum calcium of 11.2 mg/dl while on HD. Again, work-up was negative [PTH-74 pg/ml, 25(OH)D-26 pg/ml and 1,25(OH)2 D-24 pg/ml].

All of our patients had the extensive workup to rule out malignancy as a part of renal transplant evaluation and hypercalcemia was attributed to immobilization.

Discussion

Hypercalcemia due to immobilization is a result of diminished bone formation and increased bone resorption. Immobilization could be a common cause of hypercalcemia in ESRD patients than in the general population as ERSD is a low bone turnover disease and patients tend to be sicker. Immobilization should be considered a cause of hypercalcemia in ESRD patients especially when they are bed-bound and a conservative approach can be considered rather than an invasive or expansive approach of excluding malignancy.