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Abstract: SA-PO693

An Unusual Case of Hypercalcemia

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Flatow, James, Columbia University Irving Medical Center, New York, New York, United States
  • Chang, Mariana Andrea, Columbia University Irving Medical Center, New York, New York, United States
  • Arman, Farid, Columbia University Irving Medical Center, New York, New York, United States
  • Mogrovejo Pintado, Pedro David, Columbia University Irving Medical Center, New York, New York, United States
  • Al-Awqati, Qais, Columbia University Irving Medical Center, New York, New York, United States
Introduction

Antibiotic-eluting calcium sulfate beads are a method of local antibiotic delivery in infections of prosthetic material. Advantages include fewer off-target effects and greater antibiotic concentration at the site of infection than with systemic antibiotics. Hypercalcemia is a rare complication of this that has received little study to date.

Case Description

A 67-year-old man who had undergone endovascular repair of an abdominal aortic aneurysm years prior, presented with septic shock. CT demonstrated a collection in the residual aneurysm sac suggestive of an infected graft. The patient underwent graft removal with gentamicin-eluting beads placed retroperitoneally. He received 6g of calcium chloride intraoperatively and 4g of calcium gluconate over post-operative day (POD) 1; with no additional supplementation afterwards. On POD4, a basic metabolic panel showed worsening acute kidney injury (baseline sCr 0.9 mg/dL) and hypercalcemia (Table 1). Multiple etiologies for hypercalcemia were considered, including immobilization and malignancy, but none was thought to explain the acuity of the rise. The intravenous calcium administered perioperatively was expected to have been excreted by this time, and he was not on any medications associated with hypercalcemia. Workup revealed appropriately low PTH, PTHrP and low-normal Vitamin D 25-OH and 1-25 OH, pointing to the antibiotic-eluting calcium beads as main etiology. The patient was treated with aggressive fluid resuscitation and 4 doses of calcitonin, with improvement in serum calcium and creatinine as seen in Table 1.

Discussion

We present a case of hypercalcemia resulting from intraoperative placement of gentamicin-eluting calcium beads, which can occur 72-hours after insertion, and illustrates the importance of recognizing potential toxicity of local antibiotic vehicles.

Chemistries during post-operative period
Blood chemistry valuePOD1POD4POD14
Na144149145
K3.93.43.4
Cl111121108
HCO3171321
BUN424535
Cr1.671.811.37
Ca8.611.710.0
iCa1.231.871.39
Phos4.63.72.2