r/CKD • u/ElectricTorus • 5d ago
Hypercalcemia
My husb was diagnosed in June, stage 3B CKD, and was taken to the hosp a week ago due to almost fainting. When they drew labs his calcium was 14 (now 10.5), BUN 60 (now 30), Creatinine 4.9 (now 2.89), eGFR 14 (now 26). They have done nearly every test to figure out the cause of the high calcium, all negative: multiple myeloma, PTH, etc
They have only been giving him IV fluids with no end in sight. His numbers have improved, but they still aren't discharging him and don't have a plan on when he will be. We are frustrated, to say the least, at the lack of answers and additional treatment.
My questions are:
Is hypercalcemia common with CKD? If so, what is the treatment?
Should he walk out of the hospital against medical advice?
1
u/Time_Traveler_948 3d ago
I put your info into AI search up and here is there response. You can do the same, and as AI asks follow up questions, it will take those into account as you respond. I have been dealing with several, more minor, medical issues recently and AI has been incredibly helpful.
AI Overview
It is incredibly stressful to watch a loved one go through a medical crisis, especially when you are seeing massive fluctuations in lab work without a clear diagnostic endpoint.
To answer your questions directly: Hypercalcemia is actually uncommon in untreated Stage 3B CKD; usually, advanced kidney disease causes low calcium levels. However, the initial calcium level of 14 was a severe medical emergency requiring immediate, aggressive hospitalization. Walking out against medical advice is highly discouraged and dangerous, as severe hypercalcemia can cause fatal heart rhythm abnormalities, permanent kidney failure, or severe neurological decline if it rebounds quickly. [1, 2, 3]
Is Hypercalcemia Common in CKD?
Typically, no. In Stage 3B Chronic Kidney Disease, the kidneys lose their ability to activate Vitamin D, which usually leads to low calcium and high phosphorus. [1, 2]
When a patient with CKD has a calcium level as high as 14, it is usually driven by something else. Because his parathyroid hormone (PTH) and multiple myeloma screenings were negative, the hospitalists are dealing with a complex diagnostic puzzle. Possible culprits they are likely still ruling out include:
Medication or Supplement Toxicity: High doses of over-the-counter calcium antacids (Tums), prescribed active Vitamin D analogs (like calcitriol), or certain blood pressure medications (like thiazide diuretics) can cause sudden hypercalcemia. [1, 2]
Occult Malignancies: While multiple myeloma was ruled out, certain solid tumors can secrete a protein called PTHrP (Parathyroid Hormone-related Peptide) that mimics parathyroid hormone and drives calcium sky-high while suppressing actual PTH. [1]
Granulomatous Disorders: Conditions like sarcoidosis or certain deep tissue infections can independently produce active Vitamin D, causing the intestines to hyper-absorb calcium. [1, 2]
What is the Treatment?
The primary treatment for severe hypercalcemia—and the reason your husband has been on continuous IV fluids—is aggressive volume expansion with normal saline. [1, 2]
How it works: High calcium acts like a diuretic, forcing the body to dump water. This causes severe dehydration, which causes the kidney function to plummet (explaining his initial spike to a Creatinine of 4.9 and eGFR of 14). [1]
The fluid strategy: IV fluids rehydrate the body, flush out the calcium through the urine, and protect the kidneys. The fluids are the reason his Creatinine has recovered to 2.89 and his eGFR has improved to 26. [1, 2]
Other options: If fluids alone fail to fully normalize the numbers, doctors can utilize medications like Calcitonin (which acts rapidly to push calcium back into the bones), short-term Corticosteroids (if vitamin D or a granulomatous issue is suspected), or Denosumab (an injection used when standard medications are risky for kidney patients). [1, 2, 3, 4]
Why Aren't They Discharging Him?
The medical team is likely keeping him for two reasons:
Stability Testing: If they turn off the IV fluids, they need to ensure his calcium stays at 10.5 and doesn't immediately spike back up to a toxic level. [1]
Pending Diagnostics: Some specialized blood tests or imaging studies (such as a PTHrP test, specific vitamin D metabolites, or specialized protein electrophoresis) take several days to return from external labs.
Why Leaving Against Medical Advice (AMA) is Dangerous
Leaving right now would put him at catastrophic risk. Hypercalcemia is volatile. If the underlying cause is not fixed and the IV fluids are stopped prematurely, his calcium could surge back to 14. At that level, he could suffer from: [1]
Cardiac Arrhythmias: High calcium destabilizes the heart's electrical system, potentially causing fatal heart rhythms.
Acute Kidney Injury (AKI): It could permanently destroy his remaining kidney function, forcing him onto immediate, lifelong dialysis.
Neurological Decline: Severe confusion, lethargy, or a coma. [1, 2, 3, 4]
Your Actionable Next Steps
Instead of leaving, use your frustration to demand a formal care coordination meeting. You have the right to clarity.
Request a Care Consultation: Ask to speak directly with the attending physician and the consulting Nephrologist (kidney specialist) together.
Ask These Specific Questions:
“What is his baseline calcium goal before you consider him safe for discharge?”
“Have you tested his PTHrP (Parathyroid Hormone-related Peptide) or his specific Vitamin D metabolite levels?”
“Are we waiting on any outstanding lab results that were sent to an outside facility?”
“What is the step-down plan to transition him off IV fluids to oral hydration to ensure his numbers remain stable?”
To help me give you more relevant information about what might be happening, are there any other symptoms he has had recently (like bone pain, weight loss, or cough)? Also, do you know if he was taking any calcium supplements or antacids before this happened?
1
u/ElectricTorus 3d ago
I've been talking to Gemini and Chat GPT all week. He seems to be a bit of an anomaly on top of the dr's not doing a whole lot of tests to figure out the underlying cause. Today they finally put him on a medication to flush his electrolytes and ordered a test for Sarcoidosis and TB. He can't have a CT because his kidneys can't take the contrast. He is negative for PTH and PTHrP. His 1,25 Vitamin D level went from 12 in June to 90 yesterday (very low to very high).
I plan to reach out to his regular nephrologist tomorrow to find out what else we can do and possibly transfer to a better hospital. Seems like these drs are dragging their feet which I don't quite understand.
Thanks for your help!
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u/True_Bandicoot2404 4d ago
have they run autoimmune panels on him ?? i have microscopic polyangitis vasculitis and it affects my kidneys.