Severe Hypercalcemia Complicating Recovery of Acute Kidney Injury due to Rhabdomyolysis

Abstract

Patient: Male, 23Final Diagnosis: RabdomyolysisSymptoms: Cardiac arrest • cardiac arrhythmia • hypercalcemiaMedication: —Clinical Procedure: —Specialty: —Objective:Unusual clinical courseBackground:Rhabdomyolysis is frequently complicated by multiple electrolyte abnormalities, including hyperkalemia, hyperphosphatemia, and hypo/hypercalcemia. Hypercalcemia can be severe and life-threatening.Case Report:A 23-year-old white male suffered severe trauma to his lower extremities after a motor vehicle accident, leading to severe muscle damage, cardiac arrhythmia, cardiac arrest, and oliguric acute kidney injury (AKI), requiring hemodialysis treatment. As expected, he was hypocalcemic during the oliguric phase but during the diuretic phase he developed severe symptomatic hypercalcemia requiring hemodialysis treatment in spite of volume replacement and administration of pamidronate. Hypercalcemia reached a peak of 17.1 mg/dL, corrected for serum albumin and urine output was as high as 11.9 liters daily. Hypercalcemia lasted for 3 weeks and then it returned back to normal levels. Plasma levels of 25-OH and 1–25(OH)2 vitamin D were low, intact parathyroid hormone level was appropriately suppressed, and 24-hour urine calcium was 1194 mg (normal up to 350 mg/daily). Mobilization of calcium from calcium phosphate deposits in the injured muscles seems to be the main reason for hypercalcemia and hypercalciuria in rhabdomyolysis-induced AKI.Conclusions:Hypercalcemia is not uncommon during the recovery phase of ATN. Unattended, it can cause severe morbidity and even mortality. Fluid administration, pamidronate, and calcium-free dialysis are some methods used to correct severe hypercalcemia. Over time, hypercalcemia improves in almost all cases.

Severe Hypercalcemia in an Adolescent with New-Onset Diabetes Mellitus and Diabetic Ketoacidosis

“…Dehydration, even in the absence of hyperglycemia, has been reported to cause hypercalcemia [10]. Rhabdomyolysis, which is occasionally seen in DKA patients, may also lead to hypercalcemia [11]. Our patient, however, had a normal serum creatinine kinase level, ruling out muscle breakdown as the primary cause of the hypercalcemia.…”

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

“… 2 This leads to the release of muscle cell content into the circulation, which can result in multiple electrolyte abnormalities. 3 Other causes of rhabdomyolysis include alcohol, illicit substances and statins, which were excluded from the history. Autoimmune myopathies can cause rhabdomyolysis; however, there were no clinical features of this identified after rheumatological review and an autoimmune screen was normal.…”

Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States

“…Although hypocalcemia is one of the most common complications of renal dysfunction, acute kidney injury was more associated with hypercalcemia in our study. Particularly with rhabdomyolysis, the release of calcium phosphate from damaged muscles during the recovery phase might be responsible for hypercalcemia [19]. Dysnatremia is another complication of renal dysfunction.…”