Abstract
A 73-year-old woman, suffered from a sudden onset of consciousness disturbance, was transported to an emergency hospital. Right cerebellar hemorrhage and obstructive hydrocephalus were diagnosed, and single burr hole drainage was performed to remove the hematoma. The consciousness level improved gradually after the surgery, however, a few days later, the consciousness level worsened again. Computed tomography (CT) and magnetic resonance imaging did not reveal any clues as to the cause of the worsened consciousness level. She became in the shock state and transported to our hospital. On admission, laboratory data showed evidence of severe renal and liver dysfunction, hypernatremia and severe hypercalcemia. Fluid resuscitation was started, then furosemide and calcitonin were administered. The hypercalcemia improved gradually, with gradual improvement also of the consciousness disturbance. Hormonal examinations revealed hyperparathyroidism, and CT showed a parathyroid adenoma as the cause of the hypercalcemic crisis. Hypercalcemia induces polyuria and excessive thirst. If a patient's consciousness level is normal, he/she will drink water in response to the thirst; however, our patient could not drink water because of the consciousness disturbance associated with cerebellar hemorrhage, resulting in worsening of dehydration and severe hypercalcemia. In the case of unexplained consciousness disturbance in critically-ill patients, hypercalcemia should be considered as a cause of the consciousness disturbance.
