Hypercalcaemia to hypocalcaemia: tetany as a side effect of intravenous bisphosphonate treatment

Bounds, Lauren, McGrath, Felix and Taubert, Mark ORCID: https://orcid.org/0000-0003-0454-5609 2022. Hypercalcaemia to hypocalcaemia: tetany as a side effect of intravenous bisphosphonate treatment. BMJ Case Reports 15 (4) , e249141. 10.1136/bcr-2022-249141

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Abstract

A woman in her 40s with advanced bladder cancer was admitted to hospital with hypercalcaemia of malignancy. Initially, she presented with non-specific symptoms of malaise, fatigue and general deterioration. She was treated with intravenous fluids and zoledronic acid in order to bring her calcium levels down, but subsequently developed significant hypocalcaemia. This manifested as tetany in the hands in the form of bilateral carpopedal spasm. She also reported perioral paraesthesia. Bloods during her admission revealed deranged electrolytes, and her vitamin D level was on the lower scale of normal (25 nmol/L). The patient’s symptoms improved with electrolyte replacement and oral baclofen for her symptomatically distressing wrist and hand muscle spasms. This case report is a reminder that bisphosphonates can cause significant hypocalcaemia with symptoms of tetany, even when they are given for initial hypercalcaemia. Baclofen worked well to improve symptoms.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	BMJ Publishing Group
ISSN:	1757-790X
Date of First Compliant Deposit:	19 May 2022
Date of Acceptance:	17 April 2022
Last Modified:	20 Nov 2024 08:00
URI:	https://orca.cardiff.ac.uk/id/eprint/149602

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