Pamidronate in a girl with chronic renal insufficiency dependent on parenteral nutrition.
A 10-year-old 40-kg African-American female with megacystis microcolon hypoperistalsis syndrome maintained on total parenteral nutrition (TPN), with a history of metabolic bone disease and renal insufficiency, was admitted with a Candida parapsilosis central venous line infection. During her 280-day hospital stay, she had multiple episodes of bacteremia and recurrent candidemia. Furthermore, she developed pathological fractures and hip displacement with osteomyelitis due to Enterobacter. Hypercalcemia and a history of nephrocalcinosis had prevented appropriate dosing of calcium prior to and during the first months of her hospital stay. Pamidronate and chlorothiazide were added to her regimen. The urinary calcium to creatinine ratio and ionized calcium decreased. The pamidronate dose was increased to 60 mg once a week and was well tolerated. Daily calcium was added to her TPN solution and was increased to 10 mEq/day by the time of discharge. We conclude that relatively large doses of pamidronate may be required in certain cases of refractory hypercalcemia and are well tolerated in children.
Duke
Janet L
JL
Department of Pharmacy, The Center for Pediatric Pharmacokinetics and Therapeutics, Pediatric Pharmacology Research Unit, University of Tennessee Health Science Center, Tennessee, USA.
Jones
Deborah P
DP
Frizzell
Noel K
NK
Chesney
Russell W
RW
Hak
Emily B
EB
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use; D002648:Child; D002740:Chlorothiazide / Q000627:therapeutic use; D003108:Colonic Diseases / Q000150:complications; D004164:Diphosphonates / Q000627:therapeutic use*; D004232:Diuretics; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D000077268:Pamidronate; D010289:Parenteral Nutrition, Total; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D002740:Chlorothiazide; D002116:Calcitonin; D000077268:Pamidronate