Continuous Renal Replacement Therapy Might Mask Immobilization-Induced Hypercalcemia in Critically Ill Patients.
Immobilization and prolonged bed rest are harmful to the skeleton, which suffers increased resorption, and contribute to reducing survival rates among patients in critical care units. We report a patient who presented hypercalcemia 10 days after continuous venovenous hemofiltration has ended. Investigative tests showed an increase of serum C-terminal telopeptide of type I collagen (CTx), with suppressed parathormone and calcitriol. Denosumab was administered with a significant response, decreasing ionized calcium and CTx levels. The calcium infusion rate during dialysis procedures, used for citrate anticoagulation compensation, has progressively decreased, suggesting that endogenous calcium was taking part in the citrate chelation. In this report, we highlight the challenges in early diagnosis of immobilization-induced hypercalcemia among patients who are on continuous renal replacement therapy undergoing citrate anticoagulation.
['Madureira|Ricardo Mondoni|RM|', 'Callas|Silvia Helena|SH|', 'Caires|Renato Antunes|RA|', 'Ferraz Crispilho|Shirley|S|', 'Ayroza Galvão|Paulo César|PC|', 'Moysés|Rosa Maria Affonso|RMA|']
D000925:Anticoagulants D002117:Calcitriol D019343:Citric Acid D024042:Collagen Type I D000079664:Continuous Renal Replacement Therapy D016638:Critical Illness D000069448:Denosumab D006801:Humans D006934:Hypercalcemia D008297:Male D008875:Middle Aged D010281:Parathyroid Hormone D010455:Peptides D012149:Restraint, Physical
Continuous renal replacement therapy Immobilization-induced hypercalcemia Hypercalcemia Continuous venovenous hemofiltration Acute renal injury Bone reabsorption