Abstract: SA-PO0621
Diagnosis Dilemma for Hypercalcemia
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 2
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Naseem, Rabia, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Patel, Harshil Nitinkumar, Mercy Fitzgerald Hospital, Darby, Pennsylvania, United States
- Agarwal, Joshika, Mercy Fitzgerald Hospital, Darby, Pennsylvania, United States
Introduction
Immobilization-induced hypercalcemia is a rare metabolic complication resulting from decreased mechanical skeletal load due to prolonged lack of weight-bearing activity, causing increased bone resorption over formation. Other rare causes include milk-alkali syndrome, hypervitaminosis D, sarcoidosis, & medications. Symptoms include fatigue, polyuria, constipation, altered mentation, & cardiac arrhythmias. Management includes hydration, bisphosphonates, & treating underlying immobilization. This case highlights the diagnostic complexity of hypercalcemia etiology.
Case Description
A 74-year-old female with CKD stage 3b, DM, & HFpEF presented with right anterior chest pain & bilateral lower extremity edema. Labs revealed severe hypercalcemia with corrected calcium of 14.4, progressively worsening over a year, with elevated creatinine above baseline reflecting hypercalcemia-driven renal deterioration. Imaging demonstrated diffuse demineralization, soft tissue calcinosis, nephrolithiasis, & massive cardiomegaly. Neurologically, she presented with acute confusion. Extensive workup excluded malignancy, hyperparathyroidism, multiple myeloma, sarcoidosis, hypervitaminosis D, and milk-alkali syndrome. Secondary hypoparathyroidism & transient hyperthyroidism were contributing factors. Immobilization-induced hypercalcemia was established as primary diagnosis following recent mobility restriction. Management required IV hydration to promote calciuresis, calcitonin, & renally-dosed pamidronate, and physical therapy targeting the underlying immobilization.
Discussion
Hypercalcemia commonly occurs due to primary hyperparathyroidism or malignancy. Prolonged immobilization is a rare occurrence which suppresses osteoblastic activity, resulting in an imbalance favoring resorption over deposition, depleting bone mineral density with release of calcium into the bloodstream. In this case, the patient became wheel-chair bound a few months prior & presented with diffuse demineralization, & calcinosis. Renal manifestations were central — nephrolithiasis, worsening CKD, and impaired urinary calcium excretion perpetuated the hypercalcemic state. Systemically, prolonged hypercalcemia precipitates soft tissue & cardiac calcinosis. This case highlights the need for multidisciplinary management for early recognition, prevention & treatment of immobilization-induced hypercalcemia. Delayed diagnosis can lead to severe complications, including confusion, coma & cardiac arrest.