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Abstract: PO1186

Beads of Calcium

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Srialluri, Nityasree, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Carias Martinez, Karla G., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Kiernan, Elizabeth, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Monroy-Trujillo, Jose Manuel, Johns Hopkins Medicine, Baltimore, Maryland, United States

Group or Team Name

  • Hopkins Nephrology
Introduction

Hypercalcemia is a common disorder that can cause acute kidney injury (AKI) and result in significant morbidity and mortality.

Case Description

A 50-year-old male with diabetes and hypertension presented with left knee septic arthritis. He had an AKI from volume depletion and vancomycin toxicity (trough level 35.1). Incision and drainage (I&D) was done on day 13 for refractory knee infection. Postoperatively, serum creatinine (Cr) and Calcium (Ca) rose to peak Cr of 2.45mg/dL (baseline 1.04mg/dL) and a corrected Ca of 13.58mg/dL. Workup showed PTH-rP 14pg/mL, PTH 8pg/mL, 1,25-Dihydroxy Vitamin D 13pg/mL, 25-Hydroxy Vitamin D 29pg/mL and normal SPEP. Kappa/Lambda ratio was 1.55. SIFE showed IgG Kappa Monoclonal gammopathy and lambda free light chain proteinemia. Given normal SFLC and an unquantifiable M-Spike, it was ascribed to monoclonal gammopathy of undetermined significance. Recent studies including, MRI cervical, thoracic, lumbar spine, CT chest, abdomen, pelvis, and left lower extremity, did not show lytic lesions. Urine sediment showed calcium oxalate crystals. These results ruled out primary hyperparathyroidism, hypervitaminosis D, paraneoplastic syndrome, and granulomatous disease. Serum Ca improved with intravenous fluids and furosemide. It was found that in I&D, 20cc of stimulan spacer was placed, which can cause hypercalcemia. Hypercalcemia coincided with spacer placement.

Discussion

Hypercalcemia has been reported with antibiotic-eluting calcium sulfate beads (CSBs) such as stimulan in several case reports and a large cohort assessing antibiotic spacers. CSBs are used for periprosthetic joint infections for new bone formation or local antibiotic delivery. Agitation of the beads during washout is hypothesized to cause postoperative hypercalcemia. Thus, it is necessary to monitor serum Ca and Cr levels with CSBs placement. Patients with intrinsic calcium or parathyroid disorders, prolonged immobility, existing renal impairment, or critical illness are at elevated risk of developing hypercalcemia and should be observed closely.