Abstract: PO0585
An Unusual Culprit of Severe Acute Refractory Symptomatic Hypocalcemia: Keyboard Cleaner
Session Information
- Bone and Mineral Metabolism: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Khor, Si Yuan, Michigan State University, East Lansing, Michigan, United States
- Hernandez Garcilazo, Nora H., Michigan State University, East Lansing, Michigan, United States
- Sharma, Akhil, Michigan State University, East Lansing, Michigan, United States
- Wang, Enhua, Michigan State University, East Lansing, Michigan, United States
- Choi, James, Michigan State University, East Lansing, Michigan, United States
Introduction
1,1-Difluoroethane is commonly found in gas dusters and aerosol products. It has emerged as a recreational drug due to its acute euphoric effect. Side effects from difluoroethane abuse include hypocalcemia, acute kidney injury, cardiac arrhythmias and seizures. We report a case of 1,1-difluoroethane abuse presented with severe acute symptomatic hypocalcemia post Zoledronic acid therapy for Paget's disease.
Case Description
A 35 year old male with a past medical history of Paget’s disease presented with generalized muscle cramps, facial twitching and upper extremities spasms for a day. He received IV Zoledronic acid as outpatient a day prior to the onset of symptoms. He also reported a significant history of inhalant abuse with keyboard cleaners. Physical examination were unremarkable other than a positive Trousseau sign. EKG showed prolonged QTc interval of 523 ms. Initial labs revealed corrected serum calcium 4.50 mg/dL, phosphorus 1.8 mg/dL, alkaline phosphatase 455 U/L, parathyroid hormone (PTH) 201 pg/mL, 25-Hydroxyvitamin D 7.0 ng/mL and 1,25-Dihydroxyvitamin D 146 pg/mL. Over the course of 5 days, he received a total of 24 g of IV calcium gluconate and 30 g of oral calcium carbonate. His symptoms subsequently resolved and serum corrected calcium normalized to 8.04 mg/dL and PTH decreased to 169.7 pg/mL on day 5 of hospitalization. He was discharged on day 6 with plans to follow up with primary care physician for monitoring of serum calcium level.
Discussion
Incidence of severe symptomatic hypocalcemia related to Zoledronic acid therapy in Paget’s disease is uncommon (1%). Our patient was treated with Zoledronic acid in the past without complication. Besides, he lacks the risk factors for bisphosphonate-induced hypocalcemia which include hypoparathyroidism, hypomagnesemia and renal failure. Low 25-Hydroxyvitamin D on presentation is likely due to the effect of secondary hyperparathyroidism in response to hypocalcemia. Thus, we conclude that 1,1-difluoroethane is most likely the major precipitating factor for hypocalcemia seen in this case. Healthcare provider should be aware of uncommon causes of hypocalcemia such as difluoroethane as a differential once common causes have been ruled out, especially in certain susceptible populations given the ease of access for abuse and potentially fatal associated adverse effects.