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Use of disodium pamidronate in children with hypercalcemia awaiting liver transplantation
T M Attard1, A Dhawan, S S Kaufman
1Joint Section of Pediatric Gastroenterology and Nutrition, University of Nebraska Medical Center and Creighton University, Omaha, USA.
Insights
Four children with advanced liver disease and hypercalcemia experienced normalized calcium levels after receiving disodium pamidronate treatment. This suggests pamidronate is effective for managing hypercalcemia in pediatric liver disease patients.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Endocrinology
- Nephrology
Background:
- Advanced liver disease can lead to complex metabolic disturbances.
- Hypercalcemia is a potential complication in patients with severe liver dysfunction.
- Total parenteral nutrition (TPN) is a critical support method for these patients.
Purpose of the Study:
- To investigate the efficacy of disodium pamidronate in treating hypercalcemia in children with advanced liver disease.
- To evaluate pamidronate's effectiveness when standard therapies fail.
Main Methods:
- Case series of four pediatric patients with advanced liver disease awaiting transplantation.
- Patients developed hypercalcemia during total parenteral nutrition.
- Treatment involved intravenous disodium pamidronate (35-50 mg/m2) over one or two doses.
Main Results:
- All four patients presented with moderately severe hypercalcemia (1.65-2.40 mmol/L).
- Initial hypercalcemia was unresponsive to calcium restriction, loop diuretics, and calcitonin.
- Intravenous disodium pamidronate effectively normalized plasma calcium concentrations within 2-4 days in all cases.
Conclusions:
- Disodium pamidronate demonstrated significant efficacy in normalizing hypercalcemia in pediatric patients with advanced liver disease.
- Pamididronate represents a viable therapeutic option for managing refractory hypercalcemia in this specific patient population.
- Further research may explore pamidronate's role in TPN-associated hypercalcemia in liver disease.
Abstract:
We report four children with advanced liver disease awaiting liver transplantation who developed moderately severe hypercalcemia (range: 1.65-2.40 mmol/L) while receiving total parenteral nutrition. Hypercalcemia had been unresponsive to cessation of calcium intake and therapy with loop diuretics and calcitonin. One or two intravenous doses of disodium pamidronate (35-50 mg/m2) resulted in normalization of plasma calcium concentration within 2-4 d in all four children. Pamidronate may be useful for children with hypercalcemia associated with liver disease.