Bone injuries due to tetany or convulsions during hemodialysis

Two patients with long standing uremia sustained bone injuries due to tetany in one, and convulsions secondary to hemodialysis-induced alkalosis and hypomagnesemia in the other. In the former, there were multiple fractures involving the scapula, clavicles and femoral necks. In the latter, there was a slipped capital femoral epiphysis. Caution should be exercised against tetany or convulsive episodes which may cause bone injuries during hemodiaylsis in severely osteoporotic patients. In patients with progressive renal osteodystrophy, prevention of severe osteopenia by timely kidney transplant or subtotal parathyroidectomy is an important preventative measure.