Die hyperkalzämische Krise in der Intensivmedizin

Zusammenfassung

Die hyperkalzämische Krise beschreibt einen lebensbedrohlichen Zustand mit Ausfall mehrerer Organsysteme auf dem Boden einer dekompensierten Hyperkalzämie. Unbehandelt ist die hyperkalzämische Krise mit einer hohen Letalität assoziiert und erfordert deshalb ein sofortiges diagnostisches und therapeutisches Eingreifen. Besonders ein rascher Anstieg auf hohe Kalzium-Spiegel im Serum beeinträchtigt die Funktion verschiedener Organsysteme und löst eine entsprechende neurologische, renale, kardiovaskuläre und gastroenterologische Symptomatik aus. Eine hyperkalzämische Krise wird in über 90 % der Fälle durch eine tumorbedingte Hyperkalzämie oder einen primären Hyperparathyreoidismus verursacht und nur in Einzelfällen durch granulomatöse Erkrankungen oder andere endokrinologische Erkrankungen. Kausale Therapieoptionen beinhalten eine adäquate Tumortherapie bei maligner Hyperkalzämie und eine operative Sanierung beim primären Hyperparathyreoidismus. Daneben sollte eine rasche supportive Therapie zur Senkung der Kalziumspiegel eingeleitet werden. Neben einer besonders wichtigen Rehydrierung mit physiologischer Kochsalzlösung finden Schleifendiuretika, Bisphosphonate, Calcitonin, Steroide und Calcimimetika ihren Einsatz. Außer der klassischen Dialyse stellt die Citratdialyse einen neuen sehr effektiven Therapieansatz dar, der zur akuten Senkung hoher Kalziumspiegel eingesetzt werden kann.

Abstract

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.

Schlüsselwörter

Kalzium - Hyperkalzämie - hyperkalzämische Krise - Nebenschilddrüse

Keywords

Calcium - Hypercalcemia - hypercalcemic crisis - parathyroid gland

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