Yoğun Bakım Ünitesinde Şiddetli Hiperkalseminin Tedavisi
Özet
Hiperkalsemi, en sık olarak primer hiperparatiroidizm veya malignite nedeniyle oluşan ve yaygın görülen bir hastalıktır. Çoğunlukla rutin tetkikler esnasında tanı konulmakla birlikte, vakaların bir kısmı acil olarak ortaya çıkar ve bu durum önemli bir mortaliteye yol açar. Hiperkalseminin acil tedavisi, normal salinle intravenöz rehidratasyona dayanır, ancak bu yeterli olmadığında bifosfonat tedavisi kullanılır; son zamanlarda yeni bir anti-rezorptif ajan olan denosumab'ın tedavide yararlı bir rolü olduğu gösterilmiştir. Sıvı yüklenmesi riski bulunan, kalp yada böbrek yetmezlikli hastalarda veya bu tedavilerin hiç birine yanıt alınamaz ise diyaliz tedavisi uygulanabilir. Bu yazıda akciğer malignitesi tanılı bir hastada şiddetli hiperkalsemi tablosu ve yoğun bakım ünitesinde tedavi yaklaşımı anlatılmaktadır.
Hypercalcemia is a common condition that often results from primary hyperparathyroidism or malignancy. While most cases are diagnosed during routine examinations, some cases present as emergencies, leading to significant mortality. Emergency treatment for hypercalcemia is refractory to intravenous rehydration with normal saline, but when this is insufficient, bisphosphonate therapy is used. Recently, the new anti-resorptive agent denosumab has been shown to have a beneficial role in this treatment. Dialysis may be considered for patients at risk of fluid retention, those with heart or kidney failure, or those who fail to respond to any of these treatments. This article describes the presentation of severe hypercalcemia in a patient diagnosed with lung malignancy and its management in the intensive care unit.
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