PROLONGED HYPERCALCEMIA FROM ANTIBIOTIC-ELUTING CALCIUM SULFATE BEADS

Area of Science:

• Orthopedics
• Nephrology
• Endocrinology

Background:

• Calcium sulfate beads (CSBs) are biocompatible hydrophilic crystals utilized for local antibiotic delivery in periprosthetic joint infections.
• Hypercalcemia following CSB placement is an uncommon and not well-understood complication.

Observation:

• A case report details a 58-year-old woman who developed symptomatic hypercalcemia post-placement of antibiotic-eluting CSBs for a hip infection.
• The patient presented with altered mental status, respiratory failure, and septic shock, alongside severe hypercalcemia.

Findings:

• Despite no prior history of calcium disorders or relevant medications, the patient exhibited severe hypercalcemia.
• Treatment involved hydration and calcitonin; however, worsening renal failure necessitated dialysis (continuous renal replacement therapy and hemodialysis).
• Dialysis successfully normalized serum calcium levels, improved mental status, and resolved renal failure without long-term sequelae.

Implications:

• Hypercalcemia due to antibiotic-eluting CSBs, while rare, can be severe and symptomatic.
• Increased volumes of CSBs may correlate with hypercalcemia risk.
• Close monitoring of serum calcium levels post-CSB placement is crucial for timely management.