Kasperk C
Abteilung Innere Medizin I und Klinische Chemie, Sektion Osteologie, Medizinische Universitätsklinik Heidelberg, INF 410, 69120, Heidelberg, Deutschland.
Internist (Berl). 2017 Oct;58(10):1029-1036. doi: 10.1007/s00108-017-0311-3.
A serum calcium level >3.5 mmol/l together with clinical symptoms such as muscle weakness, fatigue, nausea, vomiting, pancreatitis or even coma are characteristic for a hypercalcemic crisis (HC). Primary hyperparathyroidism (1HPT) and malignancy-associated hypercalcemia are the most frequent causal diseases for a HC. The analysis of serum levels for calcium, phosphorous, intact parathyroid hormone, electrophoresis and renal function parameters indicate which further radiological, scintigraphic or serum diagnostic steps are adequate to identify the cause of the patient's acute situation (i. e. most frequently 1HPT or malignant disease with bone involvement, e. g. myeloma) and thus to initiate the required surgical or oncological intervention. However, the primary goals in the treatment of HC include correcting dehydration and improving kidney function, lowering calcium levels and decreasing osteoclastic bone resorption. The goals are accomplished by volume repletion, forced diuresis, antiresorptive agents and hemodialysis on an intensive care unit. Hypocalcemic tetany (HT) is the consequence of severely lowered calcium levels (<2.0 mmol/l), usually in patients with chronic hypocalcemia. The causal disease for hypocalcemic tetany is frequently a lack of parathyroid hormone (PTH), (e. g. as a complication of thyroid surgery) or, rarely, resistance to PTH. HT due to severe and painful clinical symptoms requires rapid i. v. calcium replacement by central venous catheter on an intensive care unit. For the treatment of chronic hypocalcemia oral calcium and 25OH-vitamin D or even 1,25(OH)2-vitamin D3 and magnesium supplements may be necessary to achieve the desired low normal calcium levels. Thiazides are useful to reduce renal calcium loss and to stabilize the calcium levels. Some patients continue to exhibit clinical symptoms despite adequate calcium levels; in these cases s. c. parathyroid hormone 1-84 should be considered to stabilize calcium levels and to lower the dosage of calcium and vitamin D supplements.
血清钙水平>3.5 mmol/L 并伴有肌肉无力、疲劳、恶心、呕吐、胰腺炎甚至昏迷等临床症状是高钙血症危象（HC）的特征。原发性甲状旁腺功能亢进（1HPT）和恶性肿瘤相关的高钙血症是 HC 最常见的病因。对血清钙、磷、完整甲状旁腺激素、电泳和肾功能参数的分析表明，哪些进一步的放射学、闪烁扫描或血清诊断步骤足以确定患者急性病情的病因（即最常见的 1HPT 或伴有骨受累的恶性疾病，如骨髓瘤），从而启动所需的手术或肿瘤学干预。然而，HC 治疗的主要目标包括纠正脱水和改善肾功能、降低钙水平以及减少破骨细胞骨吸收。这些目标通过在重症监护病房进行容量补充、强制利尿、抗吸收剂和血液透析来实现。低钙血症性手足搐搦（HT）是严重低钙水平（<2.0 mmol/L）的后果，通常发生在慢性低钙血症患者中。低钙血症性手足搐搦的病因通常是甲状旁腺激素（PTH）缺乏（例如作为甲状腺手术的并发症），或很少见的对 PTH 抵抗。由于严重且疼痛的临床症状导致的 HT 需要在重症监护病房通过中心静脉导管快速静脉补钙。对于慢性低钙血症的治疗，可能需要口服钙和 25OH - 维生素 D 甚至 1,25(OH)2 - 维生素 D3 以及镁补充剂，以达到理想的低正常钙水平。噻嗪类药物有助于减少肾脏钙流失并稳定钙水平。一些患者尽管钙水平充足仍有临床症状；在这些情况下，应考虑皮下注射甲状旁腺激素 1 - 84 以稳定钙水平并降低钙和维生素 D 补充剂的剂量。
