Hypocalcemia and Hypercalcemia in Patients with Rhabdomyolysis with and without Acute Renal Failure*

Akmal, Mohammad; Bishop, June E.; Telfer, Nancy; Norman, Anthony W.; Massry, Shaul G.

doi:10.1210/jcem-63-1-137

Cited by 110 publications

(59 citation statements)

References 22 publications

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“…The finding of suppressed iPTH during the diuretic phase in this patient is consistent with flux of calcium back into the systemic circulation as serum phosphate levels are cleared by diuresis (5). Hypercalcemia due to elevated 1, 25-(OH) 2D levels (7,8) and secondary hyperparathyroidism (9) has been reported. Calcium deposition in injured muscles is marked in patients with acute renal failure induced by rhabdomyolysis than those induced by other causes (8).…”

Section: O N I I N T E R N a Z I O N A L Isupporting

confidence: 78%

“…Hypercalcemia due to elevated 1, 25-(OH) 2D levels (7,8) and secondary hyperparathyroidism (9) has been reported. Calcium deposition in injured muscles is marked in patients with acute renal failure induced by rhabdomyolysis than those induced by other causes (8). Immobilization induces bone calcium resorption which in combination with impaired renal excretion in rhabdomyolysis with renal failure can also contribute to hypercalcemia late in the course.…”

Section: O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

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Bone scintigraphy of severe hypercalcemia following simvastatin induced rhabdomyolysis

Mirza

Amorosa

2016

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SummarySimvastatin induced rhabdomyolysis with renal failure is a well reported clinical entity with hyperkalemia recognized as a life threatening risk. The risk of delayed hypercalcemia during the recovery of renal function is not well appreciated as this varies in severity and can be caused by multiple mechanisms. We present a patient with high dose simvastatin induced rhabdomyolysis leading to late onset of severe hypercalcemia due to calcium phosphate deposition in muscles diagnosed by distinctive bone scintigraphy. A 60-year-old Asian male was admitted to the hospital for profound weakness one week following the initiation of simvastatin 80 mg daily post myocardial infarction. His clinical course was complicated by contrast nephropathy. One week later, he developed progressive weakness in all his extremities and inability to raise his head and eat. Simvastatin was discontinued at this point. CPK elevation to greater than 425,000 U was found, consistent with rhabdomyolysis. He became oliguric requiring hemodialysis. Muscle biopsy showed severe muscle necrosis and type 2 fiber atrophy. One month later, he developed hypercalcemia with suppressed intact PTH and 1, 25(OH) D levels. Whole body bone scintigraphy showed calcium phosphate deposition throughout his musculature. His calcium levels normalized in 1 week on hemodialysis. This patient's experience illustrates the marked risk of delayed severe hypercalcemia from rhabdomyolysis due to dissolution of myocellular calcium phosphate deposits. It also provides an opportunity to review the different mechanisms of hypercalcemia especially in statin induced rhabdomyolysis. Recognition of this phenomenon is critical for appropriate follow up and treatment of such patients.

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Section: O N I I N T E R N a Z I O N A L Isupporting

confidence: 78%

Section: O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Bone scintigraphy of severe hypercalcemia following simvastatin induced rhabdomyolysis

Mirza

Amorosa

2016

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“…Hypocalcaemia occurs in the first few days because of the deposition of calcium salts in damaged muscle and decreased bone responsiveness to parathyroid hormone (14,15). Because of this probability, we avoided calcium replacement.…”

Section: Discussionmentioning

confidence: 99%

Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As A Presentation Of Coeliac Disease

Sarı¹,

Güneş²,

Sarıkaya³

et al. 2010

TUTFD

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Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody.

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“…It has been observed that severe ARF requiring dialysis develops in only 3 % of rhabdomyolysis cases (3,4). Treatment of ARF due to rhabdomyolysis included hydration, alkalinization of urine, diuretics, electrolyte correction, dialysis and supportive therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Rhabdomyolysis is an important risk factor for the development of acute renal failure (ARF) (3). Rhabdomyolysis forms around 10 % of all the ARF cases (4,5). In this report, a case has been presented and literature have been searched, due to its rarity, where the developed hypocalcemia, after a thyroid operation, was severe enough to cause convulsions, rhabdomyolysis and ARF.…”

Section: Introductionmentioning

confidence: 99%

Hypocalcemia Induced Rhabdomyolysis and Acute Renal Failure After Thyroidectomy: A Case Report

et al. 2005

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Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. We report a case of a 24-year-old woman with hypocalcemia which occured after a thyroidectomy operation. This hypocalcemia was severe enough to cause convulsion, rhabdomyolysis and acute renal failure. The reason of severe hypocalcemia in our case may be multifactorial; hypoparathyroidism, rhabdomyolysis and acute renal failure. The development of hypocalcemia, convulsion attacks, rhabdomyolysis and acute renal failure occurring in the patient after iatrogenic hypoparathyroidism has rendered the case interesting due to the rarity of such developments.

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Hypocalcemia and Hypercalcemia in Patients with Rhabdomyolysis with and without Acute Renal Failure*

Cited by 110 publications

References 22 publications

Bone scintigraphy of severe hypercalcemia following simvastatin induced rhabdomyolysis

Bone scintigraphy of severe hypercalcemia following simvastatin induced rhabdomyolysis

Hypokalemic Rhabdomyolysis Induced Acute Renal Failure As A Presentation Of Coeliac Disease

Hypocalcemia Induced Rhabdomyolysis and Acute Renal Failure After Thyroidectomy: A Case Report

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