Hypocalcemia is a rare and dangerous side effect of the drug Denosumab. We present a case of a patient with metastatic prostate cancer who developed severe hypocalcemia after the administration of the drug. A total of 80 gm of intravenous and 370 gm of oral calcium were administered in vain and a maximum ionized calcium level attained was 0.71mmol/ during the first 16 days of hospital stay. Due to worsening renal failure from tumor spread our patient needed dialysis to achieve normal calcium levels. Checking calcium and Vitamin D levels prior to administration of Denosumab is very vital in preventing this adverse outcome. By presenting this case we emphasize on the importance of checking Vitamin D levels prior to administration of the drug and also make other clinicians aware of a potential severe life threatening electrolyte imbalance.
Denosumab is a fully human monoclonal antibody, administered subcutaneously, that inhibits osteoclast mediated bone resorption in bone metastases from solid tumors and multiple myeloma. See Fig A below for details.
A 45-year-old gentleman with a 3-year history of metastatic (bone, liver & lymph nodes) prostate cancer and Hypertension presented to the hospital with worsening leg swelling and hematuria. He had been treated with androgen deprivation therapy in the past, along with 3 doses of zoledronic acid for bone metastases. The bone pains were not controlled with the above regimen and hence he was switched to Denosumab. Vitals at admission were within normal limits except Blood pressure of 160/90 mmHg. Pertinent findings on physical examination were the presence of bilateral lower extremity edema and negative Chvostek and Trousseaus’s signs. Review of symptoms was positive for hematuria and leg ...
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...ence and risk of denosumab-related hypocalcemia in cancer patients: a systematic review and pooled analysis of randomized controlled studies. Qi WX, Lin F, He AN, Tang LN, Shen Z, Yao Y.
3. Severe Hypocalcemia Following Denosumab Injection in a Hemodialysis PatientBrendan B. McCormick, MD, Janet Davis, MD, and Kevin D. Burns, MD
4. Pharmaceuticals and Medical Devices Agency.: ‹http://www.info.pmda.go.jp/kinkyu_anzen/file/kinkyu20120911_1.pdf›, cited 19 April, 2013
5. Paller CJ, Carducci M, Philips G. Management of bone metastases in refractory prostate cancer—role of denosumab. Clin. Interv. Aging, 7, 363–372 (2012).
6. Buonerba C, Caraglia M, Malgieri S, Perri F, Bosso D, Federico P, Ferro M, Rizzo M, Palmieri G, Di Lorenzo G. Calcitriol: a better option than vitamin D in denosumab-treated patients with kidneyfailure? Expert Opin. Biol. Ther., 13, 149–151 (2013).
The American Dietetic Association’s position statement on Nutrition and Athletic Performance, written in conjunction with the Dietitians of Canada and the American College of Sports Medicine, makes specific references to the effects of Vitamin D, both independently and in reference to other micronutrients who are influenced by Vitamin D within the body. The American Dietetic Association’s position statement also describes that Vitamin D is required for a myriad of functions within the body, which include adequate calcium absorption, regulation of serum calcium and phosphorous levels, promotion of bone health, and regulation of homeostasis and development of the nervous system and skeletal muscles 1.
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
Phase I: An osteolytic phase characterized by noticeable and significant bone resorption and hyper vascularization.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
Prostate cancer has been the number one diagnosed cancer today. According to the World Health Organization, approximately one in every ten American men will develop prostate cancer during his lifespan. This cancer has been very common in the last few years. American Cancer Society reported over 200,000 new cases of prostate cancer. Huge number of population suffered severely. The prostate is significant for reproduction. It helps the substances that are involved in fertilization and transporting of sperm as well as survival. Prostate tumor is developed in the prostate gland, which is found in the men’s reproductive system. Prostate is the size of a walnut, which is located inferiorly in the penis and anterior to the rectum. It contains the connective tissue, which includes the glandular and fibrous tissues. This tumor starts to develop during their adolescent year due to the control of the male reproductive hormones. When the tumor starts to develop, it begins at the urethra, which is a tube that releases the urine from the bladder. The tumor is a slow development yet it is contagious to the other parts of the body, such as it does affect the pelvic bones, lungs, liver, and the lower vertebrae (Zenka, 2009).
Osteoporosis is a systemic, debilitating disease of the skeleton, characterized by significantly decreased bone mass in combination with the deterioration of bone microarchitecture. Osteoporosis has three types of categories the first category is type 1 which occurs in women after menopause and results from declining levels of estrogen and other sex hormones in the body, this could also occur in men due to low levels of the sex hormone testosterone. Type 2 is called Senile Osteoporosis, which occurs in elderly men as well as elderly women because of decreased bone formation due to aging. Type 3 is caused by long term use of medication usually with steroids and drugs to treat elipsy. Osteoporosis which literally means “Porous Bone”,
(2)Saudan,P.,Niederberger,M.,De Seigneux,S.,Romand,J.,Pugin,J.,Pernrger,T.,& Martin,P.Y(2006).Adding a dialysis dose to continuous hemofiltration increases survival in patients with acute renal failure .Kidney international,70(7),1312-1317.
Glen Carver is a 56 year old male who was admitted unto the cardiovascular care unit 48 hours ago with the diagnosis of heart failure. Mr. Carver went to see his primary care provider with complaints of dyspnea on exertion, a nonproduction cough, decreased activity intolerance, and general fatigue all of which have been worsening over the past two months. The primary care provider found Mr. Carver to have lower extremity swelling, profound ...
Chemotherapy drugs are more dangerous than other drugs because of their narrow therapeutic index. What is therapeutic index you ask? It is the ratio between a toxic dose and a therapeutic dose of a drug so any medication error with chemotherapy drugs could be a fatal one. Chemotherapy drugs can be very toxic even at the prescribed therapeutic level recommended by the physician. The findings in this article shows that the patient themselves are the first line of defense in spotting errors in medications they receive because they obs...
renal disease that requires dialysis or needing a kidney transplant. Medicare does not cover the
...essive episodes (CareNotes). As chemo is administered, patients may aquire other issues, such as a loss in appitite, less energy, sores in the mouth, pain throughout the body, an increased heartbeat, coughing or breathing issues, and confusion (CareNotes). According to CareNotes, patients must stay away from people that are sick, due to a decreased immune system, and they must drink a lot of water to stay hydrated.
The article has been well organized and written. Mackay clearly states her rationale for writing the article and provides a valid reason to hold up her article with sources. Within the introduction section, the authors present worrying statistics of Americans affected by kidney disorders. Moreover, the author provides the disadvantages of dialysis with only Kidney transplantation being the only option. The author relates the topic to the readers...
Dr. Ally, a 49-year-old professor, has been diagnosed with essential hypertension 12 years ago and was on antihypertensive drugs. However, he did not take his medications last year because he was feeling just fine. In addition, he was very busy with work. Nevertheless, he felt tired after work and developed dyspnea while climbing the stairs. Recently, he had a bout of epistaxis (severe nose bleed) with dizziness and blurred vision. He went to the doctor for a check up. His blood pressure was 180/110, and the doctor found rales or crackles on his chest upon auscultation. The doctor ordered rest and asked him to start his medication again.
Vitamin D can often be obtained with two different methods. The main method is the conversion of 7-dehydrocholesterol in the skin into Vitamin D3 via sun exposure to absorb ultraviolet B radiation with a wavelength of 290-315nm (Holick 2007). The other method, is through consumption in diets through plants in the form of Vitamin D2; or fatty fishes, supplements or fortified vitamin D products in the form of Vitamin D3 (Lavie, Lee & Milani 2011). Vitamin D undergoes hydroxylation twice; first with the enzyme 25-hydroxylase to form 25-hydroxyvitamin D (Calcidiol) (Al Mheid et al. 2013). Then, Calcidiol is converted to the most active form of Vitamin D, 1,25-dihidroxyvitamin D Hormone (Calcitriol) with the help of renal 1--hydroxylase in the kidney (Al Mheid et al. 2013). Vitamin D2 and D3 are relatively similar since share the same hydroxylation pathway to produce Calcitriol (Tripkovic 2013), however, D3 has shown to have a greater influence on Calcidiol levels and thus more effective in maintaining Vitamin D health (Heaney et al. 2011).
Chronic Kidney Disease. Mayo Foundation for Medical Education and Research, 2014. Web. 20 May 2014.