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Severe hypercalcaemia four months after acute oliguric renal failure--successful treatment with intravenous
G Crowe1, R Spedding, D R McCance
1Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
Insights
This case study shows bisphosphonates effectively treated severe hypercalcemia in a patient with acute renal failure, avoiding further dialysis. This marks a significant advancement in managing such complex cases.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Acute renal failure (ARF) can lead to complex metabolic disturbances.
- Hypercalcemia is a serious complication that may necessitate aggressive management, including dialysis.
Observation:
- A 33-year-old male with ARF post-trauma developed severe hypercalcemia.
- Initial treatments with saline and frusemide provided only temporary relief.
- The patient presented with symptoms including nausea, vomiting, blurred vision, ischemic retinopathy, and keratopathy.
Findings:
- Undetectable parathyroid hormone levels ruled out primary hyperparathyroidism.
- Sodium clodronate, a bisphosphonate, was administered intravenously.
- Successful normalization of serum calcium levels was achieved within 48 hours, maintaining normocalcemia for 17 days.
Implications:
- Bisphosphonates represent a viable and effective therapeutic option for hypercalcemia secondary to acute renal failure.
- This approach may obviate the need for dialysis in managing hypercalcemia in ARF patients.
- This case highlights a novel treatment strategy for a challenging clinical scenario.
Abstract:
A 33 year old man developed acute oliguric failure lasting 66 days, eight days after admission with multiple gun shot wounds. On day 99 after admission, serum calcium was elevated mildly at 2.54 mmol/l (normal range 2.1-2.5 mmol/l). Serum parathormone was undetectable. He was discharged soon afterwards. He presented again on day 164 with nausea, vomiting and blurred vision. Fundoscopy revealed an ischaemic retinopathy and extensive keratopathy. Serum calcium was 3.48 mmol/l and serum creatinine 262 umol/l (normal range 40-110 umol/l). Repeat parathormone was undetectable and there was no evidence of myeloma, sarcoidosis or malignancy. Following treatment with intravenous saline and frusemide, serum calcium fell to a nadir of 3.05 mmol/l. On day 168 an infusion of sodium clodronate 300 mg was given. Twenty-four hours later serum calcium was 2.65 mmol/l and 48 hours later calcium was 2.26 mmol/l. Normocalcaemia was maintained for 17 days and severe hypercalcaemia never recurred. This is the first report in which biphosphonates have been successfully used to treat hypercalcaemia following acute renal failure thus obviating the need for further dialysis.