Introduction: We describe two patients admitted to our institution with severe hypercalcaemia, resistant to conventional treatment, requiring haemofiltration. Patient 1 was admitted to hospital with profound hypercalcaemia (5.8 mmol/L) secondary to primary hyperparathyroidism (PTH >263 Pmol/L). The hypercalcaemia had been discovered on a surgical admission 3 months previously and was being managed with 0.9% normal saline and pamidronate infusions at an outside hospital. On this admission the patient was euvolaemic and had demonstrated limited responsiveness to bisphosphonates on her last infusion. In order to gain some degree of metabolic and haemodynamic control, she underwent emergency haemofiltration on ITU prior to urgent surgery to remove an aggressive parathyroid carcinoma. She suffered from post-operative hypoparathyroidism and her calcium is now well controlled with alfacalcidol. Patient 2 presented with a one week history of nausea, vomiting and diarrhoea. She was found to have a corrected calcium of 4.77 mmol/L (2.152.65) with a PTH of 0.8 pmol/L (1.66.9). Calcium levels were normalised using pamidronate and fluid hydration. A CT scan demonstrated bilateral axillary lymphadenopathy and subsequent lymph node biopsy diagnosed HTLV-1 lymphoma. She was discharged home but after commencing chemotherapy, was re-admitted a week later with a serum calcium of 6.27 mmol/L. She required urgent haemofiltration which lowered her calcium levels. With ongoing chemotherapy, she remains normocalcaemic off renal replacement therapy.
Discussion: Hypercalcaemia is a common endocrine disorder requiring treatment for either control of symptoms or prevention of its harmful sequelae. These two cases demonstrate separate scenarios (one severe hyperparathyroidism, one presumed PTHrp) in which haemofiltration was necessary to treat severe hypercalcaemia resistant to conventional treatments.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.