MON-773 - Immobilization-Associated Hypercalcemia in Mechanically Ventilated Patients: A Case Series of 16 Patients.

Immobilization-Associated Hypercalcemia in Mechanically Ventilated Patients: A Case Series of 16 Patients.
By: Dr. Madaen Abuhamidah,MD. Dr.Elochukwu Nwachukwu,MD, Lisa Brock,NP. Karen Saylor MD, Carrinne Cheney, DO. Dr. David Escalante, MD

Abstract:

Background:
Hypercalcemia in ill patients often prompts extensive evaluation for malignancy, primary hyperparathyroidism, or medication-related causes. Immobilization-induced hypercalcemia is a recognized but underreported complication in critically ill patients requiring prolonged mechanical ventilation and immobility.

Methods:
We conducted a retrospective case series of 16 adult chronic vent unit patients who developed hypercalcemia following prolonged mechanical ventilation and immobilization. Clinical data were extracted from the electronic medical record, including calcium trends, parathyroid hormone (PTH) levels, vitamin D status, exclusion of alternative etiologies, treatment strategies, and clinical outcomes.

Results:
Patients were predominantly aged 55–70 years and required prolonged respiratory care with mechanical ventilation. Hypercalcemia developed after a variable period of immobilization, with peak total calcium levels ranging from mild to severe elevations, with mean level of 12.9 and standard deviation of 1.75. Intact PTH levels were suppressed or inappropriately normal in most cases, with mean levels of 14.95. Standard deviation of 5.56, supporting a PTH-independent mechanism. Vitamin D deficiency was frequently observed when measured. Management strategies included intravenous hydration, loop diuretics, calcitonin, and intravenous bisphosphonates, most commonly pamidronate. Calcium levels normalized in the majority of patients following intervention, with sustained improvement observed on follow-up.


Conclusion:
Immobilization-associated hypercalcemia should be considered in mechanically ventilated patients who develop PTH-independent hypercalcemia after prolonged immobility. Early recognition may prevent unnecessary diagnostic testing and allow prompt, effective treatment.

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