高龄老人急性肾损伤合并高钙危象1例

Acute kidney injury associated with hypercalcemia crisis in a very old patient

我科成功诊治1例急性肾损伤（AKI）合并高钙危象的老年女性患者。患者既往有慢性肾脏病（CKD）病史，主要表现为乏力、纳差，下肢无力，血肌酐（Scr）、血钙水平明显升高。分析患者发生CKD合并AKI（A on C）和高钙血症的病因，以及两者的因果关系。进一步追问病史，并结合心电图表现，该患者被诊断为维生素D中毒。立即停用维生素D制剂及所有含钙制剂，并予以充分水化，酌情利尿以及肌肉注射鲑鱼降钙素治疗10d后，患者病情好转。本例诊治过程提示老年患者尤其是伴CKD的患者要重视对患者进行用药教育和个体化用药，并重视心电图等无创检查的临床意义以利于早期诊断。

We reported an 87-year-old female patient who suffered from acute kidney injury （AKI） associated with hypercalcemia crisis. The patient had a history of chronic kidney disease （CKD）, with main manifestations of fatigue, anorexia, lower extremity weakness, and elevated serum creatinine （Scr） and serum calcium. We made differential diagnosis and dominant position between CKD on AKI （A on C） and hypercalcemia carefully. After further questioning the medical history combined with electrocardiographic findings, the diagnosis of vitamin D intoxication was established for the patient. All the symptoms of the patient were relieved after stopping all calcium and vitamin D preparations, being fully hydrated with appropriate diuretic, as well as salmon calcitonin intramuscularly therapy for 10d. It is suggested that attention be paid to medication education and personalized medical therapy for the elderly, especially those with CKD, and electrocardiography and other non-invasive examination are of clinical significances in early diagnosis.