Q: 64 year old male with significant past medical history of end stage congestive heart failure with ejection fraction of 10-15% - awaiting left ventricular assist device (LVAD) - admitted to ICU with coma. Lab rechecked and call you with critical value of calcium level  of 16.5 mg/dL. On exam, patient is markedly in anasarca and fluid overload. What is your treatment option here?

Answer: Hemodialysis

Hemodialysis with no calcium in the dialysis fluid is an effective therapy for hypercalcemia in patients where IV hydration is not an option and immediate management is required. Nephrology service should be consulted to tailor  composition of dialysis solution.

Reference:

Koo WS, Jeon DS, Ahn SJ, et al. Calcium-free hemodialysis for the management of hypercalcemia. Nephron 1996; 72:424.