Symptomatic hypocalcaemia and renal impairment associated with bisphosphonate treatment in patients with multiple myeloma.
We report three cases of severe hypocalcaemia associated with i.v. bisphosphonate treatment in patients with multiple myeloma. All patients had symptomatic hypocalcaemia, including a tonic-clonic seizure and tachyarrhythmia in one case. Two cases were associated with the development of acute renal failure, whereas the third patient had pre-existing renal impairment. We recommend that bisphosphonates be used with caution in patients with myeloma and renal impairment, that vitamin D deficiency be corrected prior to treatment (to reduce the risk of hypocalcaemia) and that serum calcium and renal function be monitored during treatment.
Henley
D
D
Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, Western Australia, Australia. david.henley@health.wa.gov.au
Kaye
J
J
Walsh
J
J
Cull
G
G
D058186:Acute Kidney Injury / Q000139:chemically induced; D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D002117:Calcitriol / Q000627:therapeutic use; D002119:Calcium Carbonate / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007275:Injections, Intravenous; D008275:Magnesium Deficiency / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D000077268:Pamidronate; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D002117:Calcitriol; D002119:Calcium Carbonate; D000077268:Pamidronate