Endocrine Abstracts

Management of calcium disorders can be a real challenge during the different stages of acute kidney injury complicating rhabdomyolysis.

Aim: The aim of this presentation is to present a clinical case diagnosed with rhabdomyolysis, which was complicated by severe hypocalcemia during the acute phase and later on during the recovery phase with hypercalcemia.

Case presentation: We present a female patient, 57 years old, who presented to the hospital with profound weakness and difficulty in breathing. Physical examination upon admission showed normal consciousness, body temperature of 37 °C, blood pressure of 110/70 mmHg, heart rate of 98/min, and oxygen saturation 90-92%. Her initial Creatine kinase (CK) was 5852 U/l (26-192). Creatinine was 0.9 mg/dl and ionized calcium was 0.71 nmol/l (1.13-1.32) total calcium was 8.59 mg/dl (8.8-10.2), PTH 204 pg/ml (15-65), 25OHD3 24.4 ng/ml (25-80) and phosphor 7.9 mg/dl (2.5-4.5) and myoglobinuria >500 ug/ml <30. She was hospitalized because she told us that some years before she suffered a similar situation. During the clinical course in hospital, the patient was transferred to intensive care unit because she was complicated with multiple organ failure: acute kidney injury with a rapid increase in serum creatinine 8.06 mg/dl). During the oliguric phase the calcium reached the lowest level: total calcium 5.04 mg/dl and ionized calcium 0.65 mmol/l, CK was > 174608. She had some hemodialysis sessions and was discharged from hospital on day 13. During her recovery as her renal function was improving she developed progressive severe hypercalcemia with a peak calcium level 17.5 mg/dl and ionized calcium 2,15 mmol/l. Renal replacement therapy was restarted to correct hypercalcaemia. On day 30 her calcium level was normal 9.24. The patient had an excellent outcome 1 week following her discharge, calcium levels remained within normal range.

Conclusions: This case report showed us that rhabdomyolysis may present initially with severe hypocalcemia and followed by hypercalcemia. In most of the cases, these situations are self-limited and do not require specific measures other than monitoring and rehydration, but may require more intensive treatment when it becomes severe and symptomatic. Clinicians must take into account this kinetic of calcium in order to prevent the complications of hypo and or hypercalcemia.