Rhabdomyolysis and severe biphasic disturbance of calcium homeostasis secondary to COVID-19 infection

Li, Adrian Po Zhu; Thomas, Stephen; Gökmen, Refik; Kariyawasam, Dulmini

doi:10.1136/bcr-2020-239611

Cited by 6 publications

(5 citation statements)

References 9 publications

(8 reference statements)

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“…Viral infection is a recognized cause of rhabdomyolysis which often initially presents with myalgias. Similar cases of rhabdomyolysis associated with COVID-19 infection have been reported in the literature beginning in the early months of the pandemic [4][5][6][7][8][9][10][11][12][13]. Our report demonstrates a case of rhabdomyolysis with an extremely high CK value that was treated with a high flow rate of IV fluids and resolved completely with no residual kidney disease and no need for hemodialysis during treatment.…”

Section: Discussionsupporting

confidence: 81%

“…Viral infection is a recognized cause of rhabdomyolysis, which often initially presents with myalgias, as many viruses also do without concurrent rhabdomyolysis [1]. Numerous case studies have specifically reported associations between COVID-19 infection and rhabdomyolysis [4][5][6][7][8][9][10][11][12][13][14]. Thus, it is important to monitor COVID-19 patients with appropriate physical exams and labs in order to diagnose rhabdomyolysis early, initiate treatment, and mitigate downstream effects of proteinemia and myoglobinuria, such as acute kidney injury [1].…”

Section: Introductionmentioning

confidence: 99%

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Extremely Elevated Creatine Kinase in COVID-19-Associated Rhabdomyolysis

Laches,

Tillotson,

Kaufman

et al. 2023

Cureus

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Rhabdomyolysis is a condition characterized by the destruction of skeletal muscle cells with the release of myoglobin and creatine kinase into the blood. Viral infections such as influenza and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been associated with rhabdomyolysis with varying degrees of morbidity and mortality. We present the case of a male in his early thirties who was diagnosed with rhabdomyolysis associated with coronavirus disease 2019 (COVID-19) infection who developed excessively high creatine kinase levels, peaking at 1,650,000 U/L. He was treated with IV fluids and made a complete recovery.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Extremely Elevated Creatine Kinase in COVID-19-Associated Rhabdomyolysis

Laches,

Tillotson,

Kaufman

et al. 2023

Cureus

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“…Hypercalcemia has recently been linked to COVID-19, but the exact mechanism of this association remains poorly understood [ 13 ]. Although most reported cases have occurred in settings of immobilization or rhabdomyolysis due to critical illness, hypercalcemia after COVID-19 has not been commonly observed in cases of malignancy [ 14 , 15 ]. Symptomatic hypercalcemia has been recognized with both multiple myeloma and immobility in patients with COVID-19 [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Hemodialysis Treatment of Severe Hypercalcemia Following COVID-19 in Multiple Myeloma: A Case Report

Goss,

Ezaldin,

Aijaz

et al. 2023

Am J Case Rep

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Patient: Male, 67-year-old Final Diagnosis: Hypercalcemia secondary to malignancy Symptoms: Altered mental status • falls • impairment of activities of daily living Clinical Procedure: Hemodialysis Specialty: General and Internal Medicine Objective: Unusual clinical course Background: Hypercalcemia, a serum calcium exceeding 10.5 mg/dL, is a multi-factorial metabolic disorder that results from an imbalance in calcium homeostasis. Case Report: We report a case of a 67-year-old male with recently diagnosed multiple myeloma who presented to our emergency department 3 weeks after COVID-19 infection with altered mental status and a fall. On admission he was found to have severe hypercalcemia with a level over 18.0 mg/dL. Despite IV fluids, calcitonin, steroids, and zoledronic acid, he had persistent, critically elevated calcium levels. The decision to initiate hemodialysis was made, which successfully treated his hypercalcemia. Conclusions: This report presents a case of malignant hypercalcemia in an individual with COVID-19 and multiple myeloma and highlights the importance of considering dialysis as a viable treatment for hypercalcemia when other modalities have failed.

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“…The incidence of hypercalcemia in hospitalized patients with COVID-19 is rare (exact frequency unknown), but it is associated with poorer prognosis . Potential mechanisms include rhabdomyolysis, immobilization, and post–COVID-19 granulomatous disease . Fourteen children with epilepsy who were following a ketogenic diet were reported to develop hypercalcemia .…”

Section: Observations and Discussionmentioning

confidence: 99%

“…32 Potential mechanisms include rhabdomyolysis, immobilization, and post-COVID-19 granulomatous disease. [32][33][34][35][36] Fourteen children with epilepsy who were following a ketogenic diet were reported to develop hypercalcemia. 37 The mechanism, while not fully delineated, may be due to low bone formation.…”

Section: Normal Regulation Of Calciummentioning

confidence: 99%

Hypercalcemia

Walker

Shane

2022

JAMA

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ImportanceHypercalcemia affects approximately 1% of the worldwide population. Mild hypercalcemia, defined as total calcium of less than 12 mg/dL (&lt;3 mmol/L) or ionized calcium of 5.6 to 8.0 mg/dL (1.4-2 mmol/L), is usually asymptomatic but may be associated with constitutional symptoms such as fatigue and constipation in approximately 20% of people. Hypercalcemia that is severe, defined as total calcium of 14 mg/dL or greater (&gt;3.5 mmol/L) or ionized calcium of 10 mg/dL or greater (≥2.5 mmol/L) or that develops rapidly over days to weeks, can cause nausea, vomiting, dehydration, confusion, somnolence, and coma.ObservationsApproximately 90% of people with hypercalcemia have primary hyperparathyroidism (PHPT) or malignancy. Additional causes of hypercalcemia include granulomatous disease such as sarcoidosis, endocrinopathies such as thyroid disease, immobilization, genetic disorders, and medications such as thiazide diuretics and supplements such as calcium, vitamin D, or vitamin A. Hypercalcemia has been associated with sodium-glucose cotransporter 2 protein inhibitors, immune checkpoint inhibitors, denosumab discontinuation, SARS-CoV-2, ketogenic diets, and extreme exercise, but these account for less than 1% of causes. Serum intact parathyroid hormone (PTH), the most important initial test to evaluate hypercalcemia, distinguishes PTH-dependent from PTH-independent causes. In a patient with hypercalcemia, an elevated or normal PTH concentration is consistent with PHPT, while a suppressed PTH level (&lt;20 pg/mL depending on assay) indicates another cause. Mild hypercalcemia usually does not need acute intervention. If due to PHPT, parathyroidectomy may be considered depending on age, serum calcium level, and kidney or skeletal involvement. In patients older than 50 years with serum calcium levels less than 1 mg above the upper normal limit and no evidence of skeletal or kidney disease, observation may be appropriate. Initial therapy of symptomatic or severe hypercalcemia consists of hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate. In patients with kidney failure, denosumab and dialysis may be indicated. Glucocorticoids may be used as primary treatment when hypercalcemia is due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas). Treatment reduces serum calcium and improves symptoms, at least transiently. The underlying cause of hypercalcemia should be identified and treated. The prognosis for asymptomatic PHPT is excellent with either medical or surgical management. Hypercalcemia of malignancy is associated with poor survival.Conclusions and RelevanceMild hypercalcemia is typically asymptomatic, while severe hypercalcemia is associated with nausea, vomiting, dehydration, confusion, somnolence, and coma. Asymptomatic hypercalcemia due to primary hyperparathyroidism is managed with parathyroidectomy or observation with monitoring, while severe hypercalcemia is typically treated with hydration and intravenous bisphosphonates.

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Rhabdomyolysis and severe biphasic disturbance of calcium homeostasis secondary to COVID-19 infection

Cited by 6 publications

References 9 publications

Extremely Elevated Creatine Kinase in COVID-19-Associated Rhabdomyolysis

Extremely Elevated Creatine Kinase in COVID-19-Associated Rhabdomyolysis

Successful Hemodialysis Treatment of Severe Hypercalcemia Following COVID-19 in Multiple Myeloma: A Case Report

Hypercalcemia

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