Severe hypercalcaemia due to a parathyroid-type hormone-secreting tumour of the liver treated by hepatic transplantation

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Abstract
It is very rare for a patient to have to be submitted for surgery and anaesthesia with severe hypercalcaemia unresponsive to medical treatment. Problems which may be anticipated are hypertension, hypotension, cardiac dysrhythmias and renal failure. Anaesthesia for liver transplantation also requires a full appreciation of the biochemical, haematological and haemodynamic problems involved. In the present report a patient scheduled for hepatic transplantation had a consistently raised serum calcium level (4 mmol/litre) due to the secretion of a parathyroid-type hormone by hepatic tumour cells. The pre-operative management of hypercalcaemia and intra- and postoperative management of liver transplantation in this patient are presented and discussed.