Effect of calcium replacement on the hemodynamic changes associated with high dose interleukin-2 therapy.
Administration of high-dose IL-2 results in hemodynamic changes that are similar to those seen in septic shock. These include a decrease in systemic vascular resistance (SVR) with a resultant drop in mean arterial pressure (MAP). Hypocalcemia is seen in septic shock and with IL-2 administration. Calcium replacement in septic shock has been reported to result in hemodynamic improvement; we therefore administered calcium to patients receiving high dose IL-2 to correct ionized hypocalcemia. Five consecutive patients underwent invasive hemodynamic monitoring before and during IL-2 administration. Calcium chloride was administered to correct ionized hypocalcemia, and hemodynamic parameters were monitored before and after calcium administration. Ionized hypocalcemia was associated with an elevation in parathyroid hormone levels. There was no toxicity related to the administration of calcium. An improvement in the MAP and SVR was seen early and late (after a dose of IL-2 was held) in the IL-2 treatment cycle; there were minimal effects at other points. Because of the potential hemodynamic benefit of calcium replacement, we recommend that ionized hypocalcemia be corrected in patients receiving high-dose IL-2.
Redman
B G
BG
Department of Internal Medicine, Wayne State University School of Medicine, Harper Hospital, Detroit, MI 48202.
Flaherty
L
L
Martino
S
S
Kraut
M
M
Wisniewski
C
C
Valdivieso
M
M
Bander
J J
JJ
D000328:Adult; D002122:Calcium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007376:Interleukin-2 / Q000009:adverse effects* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000628:therapy; D015979:Killer Cells, Lymphokine-Activated; D008297:Male; D008545:Melanoma / Q000503:physiopathology / Q000556:secondary / Q000628:therapy; D008875:Middle Aged
D007376:Interleukin-2; D002122:Calcium Chloride