Unusual setting of medical care, Rare co-existance of disease or pathology
Sara Mahmoud, Hassan Mitwally, Hani Soliman El Zeer, Ihab El Madhoun, Mohamad Khatib
Department of Pharmacy, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
Am J Case Rep 2018; 19:1087-1089
Available online: 2018-09-13
Hypercalcemia is a common complication in the intensive care unit (ICU). It can be a result of diverse etiologies, such as malignancy. In this case, bisphosphonates can serve as an effective therapeutic option. However, bisphosphonates are not safe to use in patients with end stage renal disease.
CASE REPORT: We report a case of severe hypercalcemia possibly secondary to bone metastasis. The patient is known to have end-stage renal disease (ESRD) and undergoing dialysis 3 times a week. She had severe persistent hypercalcemia which did not resolve with regular measures or calcitonin. The literature was searched for the possibility of administering bisphosphonate as a treatment option. It was found that pamidronate pharmacokinetics can be safe and effective in end-stage renal disease patients. Therefore, Pamidronate was administered, showing effective results with regards to the level of calcium and no observed adverse effects. Re-dosing was required at an 8-week interval, with no adverse effects.
CONCLUSIONS: Pamidronate is a safe option to use in treating hypercalcemia in end-stage renal disease patients on dialysis. This can be especially beneficial in patients with sustained hypercalcemia secondary to malignancy.
Keywords: Dialysis, Hypercalcemia, Medical Oncology, Nephrology