Case Report: Denosumab Induced Hypocalcemia Refractory to Calcium Supplementation-Juniper Publishers

JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CASE STUDIES

Case Report: Denosumab Induced Hypocalcemia Refractory to Calcium Supplementation

Authored by Asish Regmi

A 70 years old female with PMH of CAD, Hyperlipidemia and recently diagnosed poorly differentiated carcinoma of unknown primary with diffuse bone metastases presented to the ED with hypotension, diaphoresis and tachycardia. Nine days before presenting to the ED she was started on Nivolumab and Denosumab. She was initially admitted with sepsis but later no source of infection was found, and antibiotics were stopped on day three. On the day of admission her calcium was 7.3mg/dl, whereas one month back it was in the normal range, which further decreased to 5.8mg/dl on 3rd day of admission. Because of her worsening hypocalcemia her Vitamin D, phosphorus and PTH level was also checked. It was noted that Vit D and phosphorus were decreased and PTH was increased. Despite the calcium gluconate her calcium level were not increasing. Nephrology was consulted and was started on calcitriol and ergocalciferol. Subsequently her calcium level started to rise and went up to 7.3, four days after initiation of therapy.

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