Successful use of zero calcium dialysate to treat hypercalcemia in a postsurgical peritoneal dialysis patient.

A 42-year-old female patient on hemodialysis (HD) developed S. aureus endocarditis of her aortic and mitral valves following the unsuccessful antibiotic treatment of an infected vascular access. She required aortic valve replacement and repair of her mitral valve. She had been receiving HD 2-3 times per week using a standard dialysate bath. Three and one-half weeks postoperatively she developed hypercalcemia with the following peak values: total calcium (t-Ca), 13.7 mg/dL; ionized calcium (i-Ca), 1.76 mmol/L. Hemodynamic instability necessitated switching from HD to peritoneal dialysis (PD). Following 48 hours of unsuccessful treatment of hypercalcemia using Baxter 2.5 mEq/L Dianeal, zero calcium dialysate prepared by our in-hospital pharmacy was used for cycler PD. Four days later the t-Ca was 10.6 mg/dL, and i-Ca was 1.32 mmol/L. Thereafter, 2.5 mEq/L calcium Dianeal was resumed. When hypercalcemia recurred (t-Ca 12.0 mg/dL and i-Ca 1.76 mmol/L), repeat use of zero calcium dialysate returned the patient's calcium values to within normal limits (t-Ca 9.0 mg/dL, i-Ca 1.20 mmol/L) by 7 days posttreatment. The results in this patient demonstrate that in-hospital pharmacies can conveniently prepare prescription-ordered dialysate and that zero calcium dialysate is yet an additional modality available to correct hypercalcemia in PD patients.