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Keto acids is widely used in dialysis patients with end-stage renal disease, which can effectively correct hypocalcemia, reduce blood PTH as well as blood phosphorus, and elevate blood albumin. Keto acids have a very low incidence of side effects. So far, no cases of Keto acids-induced severe hypercalcemia had been reported. The authors here present a case of continuous ambulatory peritoneal dialysis (CAPD) patient who repeatedly developed severe hypercalcemia accompanied by consciousness disturbance due to daily low-dose keto acids administration. In this case, common causes of hypercalcemia were excluded by thorough physical examination and investigations. The blood calcium concentration of this patient had reached 3.83 mmol/L, belonging to severe hypercalcemia, and the clinical manifestations of cognitive disorder required urgent treatment. After the suspension of keto acids, the serum calcium concentration returned to normal, and the peritoneal dialysis scheme resumed as normal after discharge, which could still maintain the normal calcium concentration. When the patient took the medicine again, severe hypercalcemia occurred as expected. After drug withdrawal, blood calcium backed to normal level, and blood phosphorus increased, which further confirmed that calcium and phosphorus metabolism disorder was closely related to the use of keto acids. This case here indicate that close monitoring of blood calcium, phosphorus and other indicators are needed, in order to prevent potential risk of hypercalcemia which would endanger the safety of patient's life.

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