Is Hypercalcemia a Frequent Complication following Local Use of Calcium Sulfate with Antibiotics for the Treatment of Extremity Posttraumatic Osteomyelitis? A Preliminary Study

Background. Previous study had reported hypercalcemia as a frequent complication (20%) following local use of antibiotic-eluting calcium sulfate (CS) during treatment of periprosthetic joint infections (PJIs). However, whether this complication may occur in patients who receive local CS implantation for management of posttraumatic osteomyelitis (OM) remains unclear. Methods. Between April 2016 and May 2017, we included 55 patients with extremity posttraumatic OM who received local antibiotic-loaded CS therapy. Serum calcium levels were detected preoperatively and on the 1st, 3rd, and 7th postoperative days (PODs). Comparisons were performed regarding serum calcium levels among the four time points and between two different CS volume groups (≤ 20 cc group and > 20 cc group). Additionally, potential associations were examined regarding CS volume and preoperative calcium level with postoperative calcium levels, respectively. Results. Altogether 46 males and 9 females were included, with a median CS volume of 20 cc. Outcomes showed that prevalence of asymptomatic hypocalcemia was more frequent, with 16.4% before surgery and 60%, 53.8%, and 25% on the 1st, 3rd, and 7th PODs, respectively. Hypercalcemia was not found in any patients, at any time point. In addition, significant differences were identified regarding serum calcium levels among different time points, suggesting significantly decreased calcium levels on the 1st (P < 0.001) and 3rd PODs (P < 0.001) and back to near preoperative level on the 7th POD (P = 0.334). However, no statistical differences were observed regarding serum calcium levels between the two CS volume groups at any time points (P > 0.05). Moreover, no significant links were identified between CS volume and postoperative calcium levels (P > 0.05). Serum calcium levels on the 3rd (P = 0.019) and 7th PODs (P = 0.036) were significantly associated with the preoperative calcium level. Conclusions. In contrast to what had occurred in PJI patients, asymptomatic hypocalcemia appeared to be more frequent in this cohort with posttraumatic OM. Hypercalcemia may be an infrequent complication before and after local CS use for the treatment of extremity posttraumatic OM.

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Serum Calcium Level Combined with Platelet Count May Be Useful Indicators for Assisted Diagnosis of Extremity Posttraumatic Osteomyelitis: A Comparative Analysis

Disease Markers ◽

10.1155/2021/6196663 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Guan-qiao Liu ◽

Nan Jiang ◽

Yan-jun Hu ◽

Qing-rong Lin ◽

Lei Wang ◽

...

Keyword(s):

Serum Calcium ◽

Calcium Level ◽

Calcium Sulfate ◽

Serum Calcium Level ◽

Area Under The Curve ◽

Roc Curves ◽

Posttraumatic Osteomyelitis ◽

Joint Infections ◽

Predictive Role ◽

Assisted Diagnosis

Background. A previous study had reported that patients with osteomyelitis (OM) appeared to be more likely to develop hypocalcemia before and after surgery. Calcium sulfate (CS) is frequently used as a local antibiotic vehicle in the treatment of OM, which may also affect serum calcium level. However, whether changes of serum calcium level are caused by OM and/or local use of calcium sulfate remains unclear. Also, platelet (PLT) count plays a crucial predictive role in periprosthetic joint infections (PJIs), but its role in assisted diagnosis of OM is largely unknown. The purpose of this study was to determine whether serum calcium level and PLT count may be helpful in assisted diagnosis of PTOM. Methods. Between January 2013 and December 2018, we analyzed 468 consecutive patients (392 males and 76 females), including 170 patients with posttraumatic OM (PTOM), 130 patients with aseptic bone nonunion (ABN), and 168 patients recovered from fractures with requirement of implant removal set as controls. Preoperative serological levels of calcium, phosphorus, and PLT were detected, and comparisons were conducted among the above three groups. Additionally, correlations and receiver operating characteristic (ROC) curves were displayed to test whether calcium level and PLT can differentiate patients with ABN and PTOM. Results. Outcomes showed that the incidences of asymptomatic hypocalcemia (PTOM vs. ABN vs. controls = 22.94 % vs. 6.92% vs. 8.82%, χ 2 = 21.098 , P < 0.001 ) and thrombocytosis (PTOM vs. ABN vs. controls = 35.3 % vs. 13.84% vs. 12.35%, χ 2 = 28.512 , P < 0.001 ) were highest in PTOM patients. Besides, the mean serological levels of phosphorus in PTOM and ABN patients were significantly higher than those in the controls ( P = 0.007 ). The Area Under the Curve (AUC) of the ROC curve outcomes revealed that, with the combination of serum calcium level with PLT count, the predictive role was acceptable (AUC 0.730, P < 0.001 , 95% CI 0.681-0.780). Also, serological levels of calcium of 2.225 mmol/L and PLT count of 246.5 × 10 9 / L were identified as the optimal cut-off values to distinguish patients with and without PTOM. However, age- and gender-related differences in serum calcium levels (age, P = 0.056 ; gender, P = 0.978 ) and PLT count (age, P = 0.363 ; gender, P = 0.799 ) were not found to be statistically significant in any groups. In addition, no significant correlations were identified between serum calcium level and PLT count ( R = 0.010 , P = 0.839 ). Conclusions. Asymptomatic hypocalcemia and thrombocytosis appeared to be more frequent in this cohort with PTOM. Serological levels of calcium and PLT count may be useful biomarkers in screening patients suspected of PTOM.

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PROLONGED HYPERCALCEMIA FROM ANTIBIOTIC-ELUTING CALCIUM SULFATE BEADS

AACE Clinical Case Reports ◽

10.4158/accr-2019-0194 ◽

2019 ◽

Vol 5 (6) ◽

pp. e349-e351 ◽

Cited By ~ 1

Author(s):

Amy Vora ◽

Sadia Ali

Keyword(s):

Renal Failure ◽

Mental Status ◽

Serum Calcium ◽

Calcium Sulfate ◽

Volume Overload ◽

Altered Mental Status ◽

Caucasian Woman ◽

Local Antibiotics ◽

Joint Infections ◽

Severe Hypercalcemia

Objective: Calcium sulfate beads (CSBs) are biocompatible hydrophilic crystals that are used to deliver local antibiotics in periprosthetic joint infections. Hypercalcemia after placement of CSBs is uncommon and poorly understood. Methods: We present the case of a woman who presented with symptomatic hypercalcemia after placement of antibiotic-eluting CSBs. Results: A 58-year-old, Caucasian woman presented with altered mental status, respiratory failure, and septic shock 2 days after placement of antibiotic-eluting CSBs for a left prosthetic hip infection. Laboratory analysis revealed severe hypercalcemia at presentation. She had no known history of fractures, kidney stones, parathyroid, or calcium disorders. She was not on any medications that could induce hypercalcemia. She was treated with aggressive intravenous hydration and 8 doses of calcitonin. Due to impaired renal function, bisphosphonate was contraindicated. She subsequently became anuric with worsening renal failure and volume overload and the decision was made to initiate dialysis. She received 8 days of continuous renal replacement therapy followed by 2 sessions of hemodialysis which improved her serum calcium levels, mental status, and renal failure with no long-term complications. Conclusion: Hypercalcemia secondary to the placement of antibiotic-eluting CSBs is rare. Larger volumes of CSBs may contribute to hypercalcemia. In some cases, hypercalcemia can be severe and symptomatic as in the case of our patient. Serum calcium levels should be monitored frequently after placement of CSBs and managed as appropriate.

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Phototherapy Induced Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia

Journal of Bahria University Medical and Dental College ◽

10.51985/gubk9588 ◽

2021 ◽

Vol 11 (1) ◽

pp. 4-8

Author(s):

Amna Khan ◽

Anila Farhat ◽

Hamayun Anwar ◽

Sajid Shamim ◽

Mujeeb Ur Rehman ◽

...

Keyword(s):

Serum Calcium ◽

Calcium Level ◽

Serum Calcium Level ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Categorical Variables ◽

P Value ◽

Cross Sectional ◽

Unconjugated Hyperbilirubinemia ◽

Before And After

Objective: To determine the frequency of hypocalcemia in neonates with unconjugated hyperbilirubinemia receivingphototherapy.Study design and setting: Cross sectional study conducted at neonatal intensive care unit, King Abdullah Teaching Hospital,Mansehra for one year from December 2017 to November 2018.Methodology: Total 213 full term stable neonates of either gender with jaundice were studied in this study. Out of which,143 with unconjugated hyperbilirubinemia were exposed to phototherapy while 70 neonates with exaggerated physiologicalhyperbilirubinemia taken as control were not exposed to phototherapy. Serum calcium level was determined through bloodtest before and after 24 hours of phototherapy. SPSS version 22 was used to analyze the data. Frequency and percentageswere used to describe categorical variables like gender and hypocalcemia. Hypocalcemia was stratified by age and genderto see effect modifiers. Post stratified chi-square test was applied in which p value = 0.05 was considered as significancevalue.Results: In study group, 143 neonates who received phototherapy had mean age of 7 days ± 2.62 SD. Total 65% neonateswere male and 35% neonates were female. Mean serum calcium level of neonates before and after provision of phototherapywas 9.28 mg/dl ± 0.23 and 8.54 mg/dl ± 0.68 respectively, which is statistically significant. The frequency of hypocalcemiawas 40% in neonates with unconjugated hyperbilirubinemia after 24 hours of phototherapy.Conclusion: Hypocalcemia is an important complication in neonates with unconjugated hyperbilirubinemia after continuousphototherapy. Hypocalcemia has clinical impact and adds to morbidity, and if left untreated, can lead to mortality.

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Phototherapy Induced Hypocalcemia in Neonates with Unconjugated Hyperbilirubinemia

Journal of Bahria University Medical and Dental College ◽

10.51985/bhrtu3452 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amna Khan ◽

Anila Farhat ◽

Hamayun Anwar ◽

Sajid Shamim ◽

Mujeeb Ur Rehman ◽

...

Keyword(s):

Serum Calcium ◽

Calcium Level ◽

Serum Calcium Level ◽

Neonatal Intensive Care ◽

Cross Sectional Study ◽

Categorical Variables ◽

P Value ◽

Cross Sectional ◽

Unconjugated Hyperbilirubinemia ◽

Before And After

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The effect of phototherapy on serum calcium level in neonates with hyperbilirubinemia: a cross sectional study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203174 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1772

Author(s):

Anjali Vasant Kale ◽

Pranoti Uttam Jadhao ◽

Aashna Valecha ◽

Sreelekha Kethepalli

Keyword(s):

Standard Deviation ◽

Serum Calcium ◽

Calcium Level ◽

Serum Calcium Level ◽

Cross Sectional Study ◽

Water Soluble ◽

Neonatal Hyperbilirubinemia ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Before And After

Background: Neonatal Hyperbilirubinemia is one of the leading causes for admission in NICU in the first week of life. This condition if left untreated may lead to irreversible neurological damage hence increasing mortality and morbidity in newborns. Neonatal Hyperbilirubinemia is treated with phototherapy which employs blue wavelengths of light to change unconjugated bilirubin in the skin. The bilirubin is then converted to less toxic water-soluble photo-isomers that are excreted in the bile and urine. There are several toxic effects to the use of this treatment, one of them being hypocalcemia.Methods: This study has been done at Mahatma Gandhi Institute of Medical Sciences in 2016-2018 on 100 new-borns to prove the effect of phototherapy on serum calcium levels in neonates with hyperbilirubinemia. New-born who were admitted in NICU for Hyperbilirubinemia were screened according to inclusion and exclusion criteria, their sample for serum calcium and serum bilirubin levels were taken as pre and post phototherapy samples.Results: It was observed that the mean Serum calcium level before phototherapy in neonates was 9.31 mg/dl with standard deviation of 0.69 mg/dl. Whereas after phototherapy mean serum calcium level in neonates was 8.88 mg/dl with standard deviation of 0.73 mg/dl. There was statistically significant mean difference in serum calcium level at before and after phototherapy in neonates (p<0.0001).Conclusions: This study proves the hypothesis that phototherapy can cause hypocalcemia in neonates with hyperbilirubinemia.

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Thiazide Treatment in Primary Hyperparathyroidism—A New Indication for an Old Medication?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-2481 ◽

2016 ◽

Vol 102 (4) ◽

pp. 1270-1276 ◽

Cited By ~ 7

Author(s):

Gloria Tsvetov ◽

Dania Hirsch ◽

Ilan Shimon ◽

Carlos Benbassat ◽

Hiba Masri-Iraqi ◽

...

Keyword(s):

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Calcium Level ◽

Serum Calcium Level ◽

Tertiary Hospital ◽

Idiopathic Hypercalciuria ◽

Urine Calcium ◽

Before And After ◽

Urine And Serum

Abstract Context: There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT. Objective: To test the safety and efficacy of thiazides in PHPT. Design: Retrospective analysis of medical records. Setting: Endocrine clinic at a tertiary hospital. Patients: Fourteen male and 58 female patients with PHPT treated with thiazides. Interventions: Data were compared for each patient before and after thiazide administration. Main Outcome Measures: Effect of thiazide on urine and serum calcium levels. Results: Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose. Conclusion: Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.

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MON-345 Hypercalcemia After Placement of Antibiotic-Loaded Calcium Sulfate Beads

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1173 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Kyrstin Lane ◽

Sarah Kim ◽

Shira Grock ◽

Matthew Freeby

Keyword(s):

Calcium Sulfate ◽

Revision Arthroplasty ◽

Calcium Sulphate ◽

Intravenous Fluids ◽

Complication Rates ◽

Joint Infections ◽

Important Complication ◽

Traditional Therapies ◽

Local Antibiotic ◽

Treatment Of Infection

Abstract Calcium sulfate beads are used to fill bone voids in bone loss and nonunion, as well as in the management of bone and joint infections.1 Specifically, Stimulan® is an absorbed form of antibiotic-loaded calcium sulfate beads which delivers high local antibiotic concentrations for treatment of infection, but has also been associated with hypercalcemia in 5.4% of cases.1 Despite the significant morbidity associated with hypercalcemia, there is little published literature describing this important complication. In our institution, five patients hospitalized between March 2019 and September 2019 with normal baseline calcium levels developed hypercalcemia as a complication of Stimulan® placement. Typically, 10 to 60 cc of Stimulan® were inserted in each surgery, with the exception of 120cc in one surgery. Three patients required a second surgery with antibiotic bead placement, and hypercalcemia occurred with both initial and subsequent surgeries. The onset of hypercalcemia varied from post-operative day one to four. The peak corrected calcium was 10.7-16.1 mg/dL which corresponded to ionized calcium of 1.57 to >2.20 mmol/L (normal 1.09-1.29 mmol/L). The patient with the highest bead volume had the highest calcium. Calcium peaked on post-operative days three to five. Patients were treated with intravenous fluids, furosemide, calcitonin and anti-resorptives including denosumab and zoledronic acid. Four patients required hemodialysis. Three patients required dialysis for symptomatic hypercalcemia and in one patient the indication was multifactorial. Calcium typically normalized by post-operative day 14 to 21, but hypercalcemia duration was unknown in two patients (one died; one had hypercalcemia on hospital discharge). As illustrated in our cases, patients who develop hypercalcemia after their initial antibiotic bead placement may be at risk for recurrent hypercalcemia if additional surgeries use antibiotic beads. Higher bead volume may be associated with more significant hypercalcemia.1 Although previous cases have reported milder hypercalcemia, our cases demonstrate that hypercalcemia can be more severe and prolonged, necessitating dialysis in addition to traditional therapies. 1-3 References: 1.Kallala R, Harris WE, Ibrahim M, Dipane M, McPherson E. Use of Stimulan absorbable calcium sulphate beads in revision lower limb arthroplasty: Safety profile and complication rates. Bone Joint Res. 2018 Nov 3;7(10):570-579. 2.Kallala R, Haddad FS. Hypercalcaemia following the use of antibiotic-eluting absorbable calcium sulphate beads in revision arthroplasty for infection. Bone Joint J. 2015 Sep;97-B(9):1237-41. 3.Carlson Jr. CR, Markulis E, Thompson E, Havill J. A novel case of hypercalcemia following the use of calcium sulfate beads. Nephrol Open J. 2015; 1(1): 17-19.

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GENERAL EFFECTS OF α-MELANOCYTE STIMULATING HORMONE IN THE RABBIT

Acta Endocrinologica ◽

10.1530/acta.0.0480609 ◽

1965 ◽

Vol 48 (4) ◽

pp. 609-618 ◽

Cited By ~ 11

Author(s):

H. K. Dyster-Aas ◽

C. E. T. Krakau

Keyword(s):

Fatty Acids ◽

Free Fatty Acids ◽

Serum Calcium ◽

Calcium Level ◽

Serum Calcium Level ◽

Systemic Effects ◽

List Type ◽

Aqueous Flare ◽

Melanocyte Stimulating Hormone ◽

Blood Aqueous Barrier

ABSTRACT In addition to the previously described permeability disturbance in the blood aqueous barrier of the eye, measured as an increase of the aqueous flare, a series of transitory systemic effects have been recorded following the subcutaneous injection of synthetic α-MSH: marked increase of the free fatty acids in plasma, decrease in the serum calcium level, decrease in the blood pressure, increase in the skin temperature, increased frequency and diminished amplitude of respiration, presence of slow waves in the EEG. There is a correlation between the magnitude of the aqueous flare increase and the increase of free fatty acids in plasma and also between the aqueous flare and the minimum serum calcium level.

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