Hypercalcemia-Induced Hypokalemic Metabolic Alkalosis in a Multiple Myeloma Patient: The Risk of Furosemide Use.
Hypercalcemia is often seen in patients with malignancies, and in the past treatment for this has traditionally included loop diuretics. Clinically, patients with hypercalcemia frequently present with polyuria and volume contraction which may be further exacerbated by diuretic therapy. In the lab, hypercalcemia has been shown to activate the calcium-sensing receptor in the thick ascending limb of Henle and inactivate the 2 chloride sodium potassium co-transporter and induce a hypokalemic metabolic alkalosis, an effect similar to that of the loop diuretic furosemide. We now report what may well be the first clinical correlate of this laboratory finding in a patient who developed a hypokalemic metabolic alkalosis as a consequence of severe hypercalcemia due to multiple myeloma and whose metabolic derangement was corrected without the use of a loop diuretic which may have exacerbated the electrolyte abnormalities.
State University of New York Health Science Center at Brooklyn, Brookdale University Hospital and Medical Center, N.Y., USA ; Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, N.Y., USA.
Ira W
IW
Reiser
Division of Brookdale University Hospital and Medical Center, Brooklyn, N.Y., USA.
Slamat
S
Ali
State University of New York Health Science Center at Brooklyn, Brookdale University Hospital and Medical Center, N.Y., USA ; Division of Hematology and Oncology, Department of Medicine, Brookdale University Hospital and Medical Center, N.Y., USA.
Vladimir
V
Gotlieb
State University of New York Health Science Center at Brooklyn, Brookdale University Hospital and Medical Center, N.Y., USA ; Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, N.Y., USA.
Samuel
S
Spitalewitz
Furosemide; Hypercalcemia; Hypokalemic metabolic alkalosis