Alfacalcidol/calcium carbonate overdose
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Calcium alkali syndrome leading to hypercalcaemic crisis: case report A 61-year-old woman developed calcium alkali syndrome (CAS) leading to hypercalcaemic crisis following overdose with calcium carbonate and alfacalcidol. The woman presented with a 10-day history of vomiting and intractable nausea. Her medical history was significant for permanent hypothyroidism and hypoparathyroidism for which she had been receiving levothyroxine sodium [levothyroxine]. In addition, she was prescribed calcium carbonate [elemental calcium] 2400mg daily and alfacalcidol 1µg per day [routes not stated]. Two months prior to the current presentation, she was in good health with normal calcium levels. Anamnesis revealed that she had been taking different preparations of OTC alfacalcidol 0.25µg–1µg per tablet for a period of 6 weeks. Additionally, she increased her daily calcium supplement up to 4800mg of calcium carbonate per day for the control of her tingling sensation. A physical examination showed that she was moderately dehydrated and drowsy. Laboratory investigations revealed profound hypercalcaemia, azotemia and mild hypophosphataemia. Her venous pH was 7.46, and electrolytes revealed metabolic alkalosis and mild hypokalaemia. A presumptive diagnosis of CAS was made from her triad of renal insufficiency (azotemia), hypercalcaemia and metabolic alkalosis. She was found to have developed hypercalcaemic crisis due to CAS [time to reaction onset not stated]. The woman was hospitalised, and she received calcitonin as well as hydration with sodium chloride [normal saline]. Calcium carbonate and alfacalcidol were discontinued. Her clinical symptoms and serum calcium level normalised in 2 days of the treatment. On day 4, she was discharged. The woman was then prescribed calcium carbonate 2000mg and alfacalcidol 0.5µg daily. At a 6-month follow-up, she did not exhibit any episode of hypercalcaemia, and her renal function returned back to baseline level. Author comment: "The key to diagnosis of CAS depends on a history of ingestion of excess [calcium carbonate] (elemental calcium more than 4 g/d) with absorbable alkali or conditions which are prone to develop metabolic alkalosis". "Patients who appear to be at high risk for CAS include old age, renal insufficiency, volume depletion state, excessive vitamin D intake [alfacalcidol]". Tingsarat W, et al. Hypercalcemic Crisis in a Patient with Post-Surgical Hypoparathyroidism. Case Reports in Endocrinology 2019: 12 Nov 2019. Available from: URL: http://doi.org/10.1155/2019/3503651 - Thailand
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Reactions 4 Jan 2020 No. 1785
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