Calcium carbonate/valsartan/hydrochlorothiazide/vitamin D
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Hypercalcaemia leading to pancreatitis in an elderly patient: case report A 68-year-old man developed hypercalcaemia leading to pancreatitis following ingestion of excessive doses of calcium carbonate. He was also taking valsartan/hydrochlorothiazide and vitamin D [not all routes and durations of treatments to reactions onsets stated]. The man, who had a history of chronic kidney disease, was admitted to an emergency department with a 4-day history of constipation, abdominal pain, nausea, and vomiting. He had tried using three saline enemas but without relief. For the previous 4–5 days, he had been taking 15–20 tablets of calcium carbonate for stomach discomfort. Each tablet contained 750mg calcium carbonate, equivalent to 300mg elemental calcium and so his daily dose of elemental calcium was 4.5-6.0g. He was also taking a D dietary supplement 5400 IU daily and the thiazide diuretic, valsartan/hydrochlorothiazide 320mg/25mg once daily. Physical examination revealed a firm abdomen with no rebound and ascites and mild tenderness in the abdominal area. He was in pain and acute distress. Tests revealed the following: calcium 18.5 mg/dL, and lipase 7091 U/L. An abdominal CT scan was performed and pancreatitis was diagnosed. The man was treated with furosemide and saline. Over time, his amylase and creatinine levels peaked at 2768 U/L and 5.07 mg/dL, respectively. His valsartan/hydrochlorothiazide was discontinued and he received pantoprazole and hydralazine. His mental status declined on day 2 to severe confusion. Shortly after developing acute respiratory distress, he was transferred to an ICU. Dialysis and intubation were started. His pancreatitis progressed to necrotising pancreatitis accompanied by abdominal compartment syndrome. He was treated with nitric oxide and high-frequency oscillatory ventilation due to progressive respiratory failure. For preservation of renal function, he began continuous venovenous haemodialysis (CVVHD). A decompressive laparotomy was conducted on day 7 with resection of part of his sigmoid colon and his small intestine. His health improved and CVVHD was stopped. A second laparotomy was performed on day 8 and a tracheostomy and abdominal washout were conducted on day 16. During the next period, his kidney function declined and he became febrile. Multiple surgeries were carried out to optimise function of his abdominal organs. For a period of 45 days, he received treatment in the ICU for pancreatitis [outcome not clearly stated]. Author comment: "According to the Naranjo Scale, calcium carbonate had a possible chance (score of 4) of causing pancreatitis." Nykamp D, et al. Antacid-induced acute pancreatitis. Consultant Pharmacist 28: 247-251, No. 4, Apr 2013. Available from: URL: http://dx.doi.org/10.4140/ 803086501 TCP.n.2013.247 - USA
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Reactions 11 May 2013 No. 1451
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