Successful treatment of severe iatrogenic hypercalcemia and acute kidney injury with hemodialysis in a cat.

Hemodialysis via CVVHDF can successfully resolve severe iatrogenic hypercalcemia and acute kidney injury in cats.

A 4-year-old male castrated domestic shorthair cat presented with urethral obstruction and subsequently developed severe iatrogenic hypercalcemia (ionized calcium >4 mmol/L, total calcium 57 mg/dL) and acute kidney injury (creatinine 9.81 mg/dL), suspected to result from a calcium gluconate overdose. Approximately 12 hours post-admission, the cat became comatose with cardiovascular instability, necessitating urgent intervention. A 6-hour hemodialysis session was performed using continuous venovenous hemodiafiltration (CVVHDF) on the Prismaflex platform, which successfully resolved the hypercalcemia. Creatinine normalized to 1.01 mg/dL within 72 hours, and the cat was discharged after 6 days of hospitalization. Following discharge, the cat developed upper respiratory and gastrointestinal signs. Endoscopic and bronchoscopic evaluation revealed diffuse calcification of the trachea and gastric mucosa, representing long-term sequelae of the severe hypercalcemic event. This case highlights the critical importance of careful calcium gluconate dosing in clinical practice and underscores the life-saving potential of hemodialysis—specifically CVVHDF—in managing severe, refractory hypercalcemia and associated acute kidney injury in cats. It also provides important documentation of potential chronic complications, including metastatic calcification of soft tissues, that may persist even after successful acute management.

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