Hyperacute Fatal Course in a Hypercalcemic Crisis A Clinical Case Study

Introduction

Hypercalcemic crisis is a life-threatening medical emergency that can lead to severe cardiac and renal complications. This case study highlights the hyperacute fatal progression of a hypercalcemic crisis in a previously healthy 39-year-old woman.

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Case Summary

A 39-year-old woman presented to the Emergency Department with nausea, vomiting, constipation, asthenia, and muscle cramps. Initial assessments revealed dehydration, hypokalemia, and elevated beta-human chorionic gonadotropin (β-hCG) levels. Suspecting hyperemesis gravidarum, rehydration and potassium reintegration therapy were initiated. However, the patient’s condition deteriorated, with a sudden increase in calcium levels to 21.1 mg/dL (normal: 9-10.5 mg/dL) and parathormone (PTH) exceeding 3000 pg/mL (normal: 14-65 pg/mL).

Despite medical efforts, the patient experienced rapid decline and succumbed to the condition before appropriate therapy could begin.

Key Findings and Pathology Reports

• Renal Impact: Histological examination revealed severe nephrolithiasis and nephrocalcinosis.
• Parathyroid Involvement: A left parathyroid nodule (4x2x1.5 cm) with hemorrhagic aspects was identified, diagnosed as atypical adenoma with neoplastic embolism.
• Cardiac Complications: High serum calcium led to QT shortening and contraction band necrosis, contributing to fatal cardiac arrhythmia.

Read the full study: https://doi.com/10.29328/journal.jcn.1001066

Hypercalcemic Crisis: A Critical Condition

Hypercalcemic crisis (calcium levels > 15-18 mg/dL) requires immediate intervention to prevent renal failure, cardiac arrest, and death. Treatment typically includes:
Aggressive rehydration therapy
Calcium-free hemodialysis for renal insufficiency
Parathyroidectomy in cases of adenoma

Clinical Insight: Early calcium screening in symptomatic patients is crucial to avoid delays in treatment.

Broader Implications in Nephrology & Endocrinology

The American College of Endocrinology emphasizes early detection and aggressive management of primary hyperparathyroidism to prevent fatal complications. Furthermore, studies highlight the role of hemodialysis as an effective intervention for severe hypercalcemia 1,2

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Conclusion

Hypercalcemic crises are rare but highly fatal if not managed promptly. Clinicians should maintain a high index of suspicion in patients presenting with unexplained neurological and gastrointestinal symptoms.

Find more details in our published case report: DOI: 10.29328/journal.jcn.1001066.

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