Burns
Volume 36, Issue 3 , Pages 360-366, May 2010

Hypercalcaemia and acute renal failure after major burns: An under-diagnosed condition

  • Barbara Kohut

      Affiliations

    • Department of Intensive Care Medicine & Burns Centre, University Hospital (CHUV), CH-1011 Lausanne, Switzerland
    • ,
  • Julien Rossat

      Affiliations

    • Department of Anesthesiology, CHUV, CH-1011 Lausanne, Switzerland
    • ,
  • Wassim Raffoul

      Affiliations

    • Department of Plastic and Reconstructive Surgery, CHUV, CH-1011 Lausanne, Switzerland
    • ,
  • Olivier Lamy

      Affiliations

    • Department of Internal Medicine, CHUV, CH-1011 Lausanne, Switzerland
    • ,
  • Mette M. Berger

      Affiliations

    • Department of Intensive Care Medicine & Burns Centre, University Hospital (CHUV), CH-1011 Lausanne, Switzerland
    • Corresponding Author InformationCorresponding author at: Department of Intensive Care Medicine & Burns Centre, CHUV BH-08.612, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Tel.: +41 21 31 42 095; fax: +41 21 31 43 045.

Accepted 11 May 2009.

Abstract 

Background

Hypercalcaemia has been shown to occur in about 20% of patients with major burns requiring prolonged intensive care unit (ICU) treatment, and it may be associated with renal failure. Having observed the early onset of hypercalcaemia, the study aimed to determine the frequency and timing of this condition in a European patient cohort.

Methods

A retrospective cohort study on a prospectively collected, computerised database of the 225 burn-injury ICU admissions between 2001 and 2007 was undertaken. The inclusion criteria included: burns >20% of the body surface area (BSA) or in-hospital stay >20 days. Hypercalcaemia was defined as an ionised plasma calcium (Ca2+) concentration >1.32mmoll−1 (or total corrected calcium=[Ca]c>2.55mmoll−1). Four emblematic cases are reported in this article.

Results

A total of 73 patients met the inclusion criteria (age: 13–88 years, burns: 12–85% BSA): of these, 22 (30%) developed hypercalcaemia. The median time to the first hypercalcaemia value was 21 days. Only 11 patients had both high Ca2+ and elevated [Ca]c (which remained normal in others). The risk factors of the disorder were burned surface (p=0.017) and immobilisation (fluidised bed use: p<0.05, duration: p=0.02) followed by burned BSA. Acute renal failure tended to be more frequent in hypercalcaemic patients (five (23%) vs. three (6%): p=0.11), while mortality was not increased. The disorder resolved with hydration and mobilisation in most cases: pamidronate was successful in three cases that were most severe.

Conclusion

Hypercalcaemia and associated acute renal failure occur more frequently and earlier than previously reported. Determining the ionised Ca rather than the total Ca with albumin correction enables earlier detection of hypercalcaemia. Bisphosphonates are an effective treatment option in controlling severe hypercalcaemia and preventing bone loss.

Keywords: Bisphosphonates, Bone metabolism, Hypercalcaemia, Hypoalbuminaemia, Immobilisation

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PII: S0305-4179(09)00149-1

doi:10.1016/j.burns.2009.05.001

Burns
Volume 36, Issue 3 , Pages 360-366, May 2010

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