Severe Hypercalcemia Following the Implantation of Antibiotic Impregnated Calcium Sulfate Beads for Prosthetic Joint Infection

Calcium sulfate antibiotic‐impregnated bead implantation for deep surgical site infection associated with orthopedic surgery in small animals

“…Similarly, bead‐associated complications were not identified in prior reports describing the use of calcium sulfate beads in small animals 21,22 . Adverse events such as hypercalcemia and wound drainage previously documented in man were not evident in our cases 18,38‐41 . Iatrogenic hypercalcemia is a potentially serious complication of calcium sulfate bead implantation that may be related to use of excessive volumes 38‐41 .…”

“…18,[38][39][40][41] Iatrogenic hypercalcemia is a potentially serious complication of calcium sulfate bead implantation that may be related to use of excessive volumes. [38][39][40][41] In man, limiting volumes to 40 cm 3 per site has been recommended; the commercially available veterinary product provides 15 cm 3 of beads. 38 However, serum calcium levels remained within normal limits in dogs in which calcium sulfate beads were experimentally implanted, even at 1.8 times the maximum prescribed human dose.…”

“…21,22 Adverse events such as hypercalcemia and wound drainage previously documented in man were not evident in our cases. 18,[38][39][40][41] Iatrogenic hypercalcemia is a potentially serious complication of calcium sulfate bead implantation that may be related to use of excessive volumes. [38][39][40][41] In man, limiting volumes to 40 cm 3 per site has been recommended; the commercially available veterinary product provides 15 cm 3 of beads.…”

“…35 Although serum levels of calcium are not routinely measured in clinical veterinary cases after bead implantation, clinical signs of hypercalcemia have not been reported with calcium sulfate beads. 21,22 Calcium sulfate beads may also promote excessive fluid production due to alterations in wound osmolality, 40,41 but this complication has not been observed in small animals. While we documented a low complication rate, our case series sample was small, and clinicians should still be aware of these additional potential complications in animals.…”

A Case of Hypercalcemia and Antibiotic-Related Acute Kidney Injury Following Implantation of Antibiotic Impregnated Calcium Sulfate Beads

“…In a case series involving 15 patients who underwent revision surgery for prosthetic joint infection using absorbable calcium sulfate beads, three patients developed hypercalcemia (two were transient and asymptomatic, and one had severe hypercalcemia [calcium level of 3.5 mmol/L] on postoperative day 5, requiring intensive care unit [ICU] admission) [2]. Three other cases of clinically significant hypercalcemia in association with calcium sulfate bead utilization have also been reported [345]. Interestingly, all these cases presented more than 72 hours following surgery.…”