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Review article : Medical complications in acute rehabilitation unit: immobilization hypercalcaemia

Department of Rheumatology, Bowman Gray School of Medicine, Winston-Salem

Elliott L Semble

Department of Rheumatology, Bowman Gray School of Medicine, Winston-Salem

Catherine N Miller

Department of Rheumatology, Bowman Gray School of Medicine, Winston-Salem

Immobilization hypercalcaemia has been documented in adolescents on prolonged bed rest, particularly after traumatic fractures or spinal cord injuries. The exact pathophysiological mechanisms which produce the syndrome are unknown. Unstressed bone relinquishes calcium stores and the resulting hypercalcaemia leads to disturbances of many organ systems. Medical emergencies may occur if hypercalcaemia is unchecked. Medical management does not alter the underlying bone resorption, which follows a self-limited course, but can prevent serious complications and permanent renal damage. Acute rehabilitation professionals should be knowledgeable regarding immobilization hypercalcaemia as vague symptom presentations make recognition difficult. Also, immobilization hypercalcaemia occurs in time frames which coincide with most acute rehabilitation efforts and the syndrome can impede progress in reaching rehabilitation goals. Mobilization remains the only effective means to halt hypercalcaemia, although other therapeutic interventions may lessen its deleterious effects.

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