Abstract: PUB269
Hypercalcemia: Immobility's Insidious Impact and Navigating Rhabdomyolysis
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Teferici, Stela, NYC Health and Hospitals Elmhurst Department of Emergency Medicine and Urgent Care, Queens, New York, United States
- Munoz Casablanca, Nitzy N., NYC Health and Hospitals Elmhurst Department of Emergency Medicine and Urgent Care, Queens, New York, United States
- Khan, Hameeda Tayyab, NYC Health and Hospitals Elmhurst Department of Emergency Medicine and Urgent Care, Queens, New York, United States
Introduction
Hypercalcemia is a well-recognized complication. This case report explores less frequent etiologies: hypercalcemia occurring during the recovery phase of rhabdomyolysis and hypercalcemia due to immobilization.
Case Description
A 33-year-old man was found intoxicated on the street. On presentation, he displayed dilated pupils, tachypnea, and altered mental status, necessitating endotracheal intubation. Drug screen showed cocaine, benzodiazepines, and opioids. Additionally, he reported ingesting a banned weight-loss substance, raising concern for serotonin syndrome. He developed renal failure from rhabdomyolysis (creatine kinase level of 69,020 U/L), requiring renal replacement. Hospital course was further complicated by bacterial pneumonia with superimposed fungal infection, requiring eventual tracheostomy and percutaneous endoscopic gastrostomy tube placement. Despite kidney recovery and normal urine output, hypercalcemia recurred (12 mg/dl ) and was unresponsive to several interventions (see Diagram 1). Work up showed low Vitamin D levels, low Parathyroid hormone level (PTH 7 pg/ml , phosphorus relatively normal , and mildly elevated Alkaline phosphatase (160 IU/L). Elevated collagen telopeptide 2369 pg/ml indicated PTH-independent hypercalcemia. Imaging revealed no abdominal or pelvic mass making malignancy unlikely. Normocalcemia was eventually achieved with calcium-free hemodialysis.
Diagram 1.
Discussion
Rhabdomyolysis, though initially often causing hypocalcemia from muscle uptake, can lead to rebound hypercalcemia in up to a third of patients during recovery, due to the release of deposited calcium. However, our patient developed severe hypercalcemia despite resolution of rhabdomyolysis with workup indicating hypercalcemia of immobilization. Prolonged immobilization can cause bone resorption and hypercalcemia, especially in critically ill patients with high bone turnover. Fluid administration, pamidronate, and calcium-free dialysis are some methods used to correct severe hypercalcemia. Our case highlights one of the less common causes of hypercalcemia