A MEDICAL EMERGENCY: HYPERCALCEMIC CRISIS DUE TO VITAMIN D MISUSE REQUIRING HEMODIALYSIS

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

Am J Kidney Dis

Abstract

Hypercalcemic crisis results from severe hypercalcemia leading to renal failure and altered mental status. Primary hyperparathyroidism and hypercalcemia of malignancy are the most frequent causes of hypercalcemic crisis. Rarely, vitamin D intoxication can cause it as well. A 58-year-old female presented with altered mental status and somnolence to the emergency room. On physical examination, the patient was obtunded. Vital signs included blood pressure 118/74 mm Hg, heart rate 106 beats per minute, temperature 36.4 degrees Centigrade, breathing 12 respirations/minute. Laboratory workup revealed severe hypercalcemia 15.1 mg/dl, ionized calcium of 1.71 mmol/l, lactic acid 9.2 mmol/l, potassium 8.1 mEq/l, BUN 106 mg/dl, creatinine 13.17 mg/dl, elevated 25-hydroxyvitamin D above 120 ng/ml, elevated 1,25-dihydroxyvitamin D of 168 pg/ml, normal intact PTH 45 pg/ml, low PTH related protein 10 pg/ml, urine albumin/creatinine ratio 3,893 mg/g, urine protein/creatinine ratio 10.70 g/g. Kidney biopsy showed acute tubular injury and nodular diabetic glomerulosclerosis. The patient initiated emergent hemodialysis. There was gradual improvement in the patient's mental status and calcium level after serial treatments with continuous and intermittent hemodialysis. As she became more alert, she endorsed taking over the counter cholecalciferol >10,000 I.U. a day over several months. Her calcium levels and renal function improved, and hemodialysis was stopped prior to discharge. Her hypercalcemia and 1,25-dihydroxyvitamin D is slowly improving and her 25-hydroxyvitamin D remains elevated above 120 ng/mL one month later. Due to the increasing use of vitamin D supplementation, patients should be educated and made aware of severe, potentially life-threatening adverse effects. Hemodialysis is rare, but efficient mode of therapy in hypercalcemic crisis.

Volume

83

Issue

4

First Page

S28

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