Pamidronate for Hypercalcemia in Critically Ill Surgical Patients.

Introduction: Hypercalcemia in critically ill patients is associated with an increased severity of illness and mortality that becomes worse as the levels rise. Pamidronate was evaluated for the treatment of hypercalcemia in critically ill surgical patients.
Methods: This retrospective study evaluated 30 critically ill surgical patients who developed hypercalcemia (ionized calcium (iCa)≥1.25 mmol/L) while in the surgical ICUs over three years. Patients were case-matched 1:1 for age and severity of illness.
Results: In the 30 patients with an overall Acute Physiology and Chronic Health Evaluation (APACHE) II of 22±9, mechanical ventilation was required in 27/30 (90%) and hemodialysis in 11/30 (37%). Within four days of pamidronate, iCa declined from a mean of 1.46±0.14 to 1.15±0.14 mmol/L, p=0.004; however, the blood urea nitrogen (BUN) and serum creatinine (SCr) increased significantly in patients with renal impairment. An iCa≥1.35 mmol/L increased mortality from 0% to 26%.
Conclusions: Hypercalcemia in critically ill surgical patients is associated with increased severity of illness. Over a period of four days, pamidronate reduced iCa levels at ~0.08 mmol/L/day and corrected 80% of the hypercalcemic patients; however, it may cause further renal dysfunction.
Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Detroit Medical Center issued approval 12223. The IRB granted exemption as this is a retrospective study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
(Copyright © 2024, Hall Zimmerman et al.)