A case of severe hypercalcemia with arterial and venous thrombosis | Anaesthesia, Pain and Intensive Care 2020

Author(s)

Haifa Mesfer Algethamy Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah (Saudi Arabia)

Yasamen Abdulmannan Shikdar Department of Medicine, King Abdulaziz University Hospital, Jeddah (Saudi Arabia)

Tariq A. Alansari Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah (Saudi Arabia)

Abstract

We present a case of severe hypercalcemia with extensive venous and arterial thrombosis that led to the patient’s demise in the setting of possible multiple endocrine neoplasia (MEN) type 2a. A 35-year-old female presented to the emergency with nausea and vomiting for one week. Physical examination revealed dry mucous membranes, a thyroid nodule on left side and epigastric tenderness. Initial investigations revealed evidence of renal impairment and hypercalcemia. Parathyroid hormone (PTH) level was very high. Ultrasound of the thyroid showed a solitary left thyroid nodule with mixed cystic and solid isoechoic echogenicity. The patient developed progressive dyspnea and hypoxemia, which mandated mechanical ventilation. Dialysis was initiated via the right femoral catheter and stopped due to extensive venous thrombosis of the right lower limb. Pulmonary emboli were excluded and pulmonary edema was confirmed by computed tomography. The patient was subsequently intubated for persistent respiratory distress. The same condition occurred in the right upper limb. Fine needle biopsy of the left thyroid nodule revealed medullary thyroid cancer. The consulting team preferred to manage her conservatively as she was rapidly-deteriorating. She developed progressive shock and multi-organ failure and expired.

Publication Details

Page(s) 111-114

DOI DOI not available

Published Journal: Anaesthesia, Pain and Intensive Care, Volume: 24, Issue: 1, Year: 2020

Keywords

Hypercalcemia Hyperparathyroidism Thrombosis Limb ischemia Medullary thyroid cancer Multiple endocrine neoplasia

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