個案報告：肺結核合併高血鈣與多重疾病之高齡個案

Case Report: An Elderly Patient with Pulmonary Tuberculosis Presented with Hypercalcemia and Multi-comorbidity

陳家宏(Chia-Hung Chen) ； 彭莉甯(Li-Ning Peng) ； 林明憲(Ming-Hsien Lin)

《台灣老年醫學暨老年學會雜誌》 14卷4期 (2019/11) Pp. 251-263

https://doi.org/10.29461/TGGa.201911_14(4).0006

摘要

高血鈣是臨床上常見的電解質失衡，其與副甲狀腺素及維生素D的調節作用息息相關，高齡者發生高血鈣時，有著不同於一般成年人的臨床表現，背後引發的病因也有所差異。本文討論之個案是一位85歲女性患者，主訴全身無力及活動量下降，經診察發現肺部感染、腎臟衰竭且合併有高血鈣情形，依循高血鈣之診斷流程，發現高血鈣疑似為肺結核所致。本文藉此個案的臨床表徵與檢查結果，輔以文獻回顧，探討肺結核及其他可能造成高血鈣的病因、臨床實務上鑑別診斷的方法與思考流程、高齡者對於血鈣調節的特色，及高齡者發生高血鈣的評估方式。此個案因接受藥物治療效果不佳，經由血液透析治療後使血鈣趨於穩定，並投予抗結核藥物治療肺結核。本文描述個案住院期間所接受針對高血鈣之治療，並探討各種治療藥物的使用時機、持續效用時間與禁忌，及血液透析治療的適應症。針對高血鈣病因的治療，除了藥物外，也進一步探討手術治療在高血鈣症中的角色。

關鍵字

高血鈣 ； 肺結核 ； 高齡者

並列摘要

Hypercalcemia is a common form of electrolyte imbalance in clinical setting. It is highly associated with regulation of parathyroid hormone and vitamin D. In this case report, we presented an 85-year-old women with chief complaints of general weakness and decreased daily activity. Pulmonary infection, acute kidney injury, chronic kidney disease, and hypercalcemia were diagnosed after history taking, physical examination, and image and laboratory examinations. During hospitalization, hypercalcemia was highly suspected as being induced by pulmonary tuberculosis after following diagnostic algorithm of hypercalcemia. Based on clinical manifestations, image findings, laboratory data, and literature review, we explored causes of hypercalcemia other than tuberculosis, the process and algorithm for differential diagnosis of hypercalcemia in clinical practice, the differences in physiological regulation of serum calcium in the elderly, and special concerns of assessing and treating hypercalcemia presented in the elderly. Due to the patient's poor response to medical treatment, her serum calcium was stabilized after receiving hemodialysis. Anti-tuberculosis treatment was also applied after confirming diagnosis of pulmonary tuberculosis. We presented the treatment course for hypercalcemia in this case and discussed further therapeutic choices, principles, and strategies of treating hypercalcemia. This article also covered implication of hemodialysis for hypercalcemia and the role of surgical treatment for patients with hypercalcemia.

並列關鍵字

hypercalcemia ； tuberculosis ； elderly