Au Selena, Dunham Michael, Godinez Tomas
Department of Critical Care Medicine, University of Calgary, Alberta, Canada.
Int J Artif Organs. 2012 Jul;35(7):538-41. doi: 10.5301/ijao.5000089.
A 58-year-old patient was admitted to the intensive care unit for severe hypercalcemia (total Ca 5.30 mmol/L) complicated with status epilepticus, hypertensive crisis and acute renal failure. Renal replacement therapy was explored as a method for treating medically refractory hypercalcemia.
Because of hemodynamic instability during intermittent hemodialysis (IHD), continuous venovenous hemofiltration (CVVH) with high rates of calcium-free replacement fluids was instituted. Epoprostenol rather than citrate was used as anticoagulation to ensure adequate extracorporeal anticoagulation.
CVVH was continued for 40 hours total during which ionized calcium decreased from 2.19 to 1.07 mmol/L. The etiology of the hypercalcemia was from autoinfarction of a parathyroid adenoma.
This is the first case of hypercalcemia treated with CVVH with epoprostenol anticoagulation. This method avoids some of the pitfalls of using intermittent hemodialysis. It is also a rare example of hypercalcemia induced posterior reversible encephalopathy syndrome (PRES).
一名58岁患者因严重高钙血症（总钙5.30 mmol/L）合并癫痫持续状态、高血压危象和急性肾衰竭入住重症监护病房。探索采用肾脏替代疗法治疗药物难治性高钙血症。
由于间歇性血液透析（IHD）期间血流动力学不稳定，遂采用高流量无钙置换液的连续性静脉-静脉血液滤过（CVVH）。使用依前列醇而非枸橼酸盐进行抗凝，以确保体外循环有足够的抗凝效果。
CVVH总共持续了40小时，在此期间，离子钙从2.19 mmol/L降至1.07 mmol/L。高钙血症的病因是甲状旁腺腺瘤自动梗死。
这是首例采用依前列醇抗凝的CVVH治疗高钙血症的病例。该方法避免了使用间歇性血液透析的一些缺陷。这也是高钙血症诱发后部可逆性脑病综合征（PRES）的罕见病例。
