[Hypercalcemic crisis in intensive care].

A hypercalcemic crisis is a life-threatening disease with multiorgan failure due to severe hypercalcemia. If left untreated, a hypercalcemic crisis is associated with a very high mortality and requires immediate diagnostic and therapeutic interventions. Especially a rapid rise to high calcium levels impairs the function of several organ systems and leads to central nervous, renal, cardiovascular and gastrointestinal symptoms. A hypercalcemic crisis is caused in more than 90 % by malignancy or primary hyperparathyreoidism and only in very rare cases by other diseases such as granulomatous diseases or other endocrinological diseases. Causal therapeutic options include an adequate treatment of malignancy and a surgical resection of the adenomatous tissue in primary hyperparathyreoidism. In addition, an adequate supportive therapy to lower calcium levels should be initiated as soon as possible. Rehydration with normal saline is the mainstay of therapy. Additional pharmacological therapies include biphosphonates, loop diuretics, calcitonin, steroids and calcimimetics. Besides classic hemodialysis continous renal replacement therapy with citrate anticoagulation is new therapeutical approach that can be used for the acute reduction of elevated serum calcium levels.