Hypercalcaemic crisis is a rare but life-threatening condition involving the decompensation of hypercalcaemia (usually when serum calcium > 13-15 mg/dL) with significant disturbance to cardiac, renal, gastrointestinal and neurological function. Although major textbooks have thorough and detailed reviews of hypercalcaemia, there are no articles elaborating specifically the aetiology and pathophysiology of hypercalcaemic crisis. The goal of this study was to identify the aetiologies and risk factors of hypercalcaemic crisis. We performed a retrospective review from 01/2012 to 05/2014 of patients with hypercalcaemia at our tertiary care centre and analszed their characteristics. Sixty-two patients with severe hypercalcaemia (adjusted serum calcium level by albumin ≧ 13.5 mg/dL) were identified from 262 of hypercalcaemia. Demographic and clinical characteristics were evaluated. Our study revealed that there were no differences in the aetiologies between hypercalcaemic crisis (pHPT/malignancy/others: 15%/60%/25%) and severe hypercalcaemia without crisis (pHPT/malignancy/others: 7.1%/64.3%/28.6%, P=0.617). Compared with severe hypercalcaemia without crisis, the serum calcium level was significantly higher in hypercalcaemic crisis (16.9±1.8 mg/dL vs 14.8±1.1 mg/dL, P < 0.001). However, no differences in serum calcium level were observed among the subgroups of different aetiologies in hypercalcaemic crisis (P=0.662) or severe hypercalcaemia without crisis (P=0.423). The logistic regression analysis showed that serum calcium level (OR =3.66; 95% CI: 1.83 to 7.31) and age (OR =1.06; 95% CI: 1.00 to 1.13) were independent risk factors for hypercalcaemic crisis. The multivariate linear regression analysis showed that significant predictors of serum calcium level in hypercalcaemic crisis were age (β=-0.694, P=0.001) and AKI (β=0.449, P=0.013). To our knowledge, this is the first and most comprehensive study to investigate the aetiology and risk factors of hypercalcaemic crisis. The accurate assessment of risk before investigating aetiology has an important place in hypercalcaemic crisis screening.
Disclosure: The authors declared no competing interests.