Would have thought he ought to be reviewed by a metabolic physician/
endocrinologist before further measures are taken. what has happened to his
PO4 and what are his PTH & vit D levels. What about his worsening CRF? Is
there a tubular leak?
rgds
A
Ahmed Waise
York Hospital,
YORK YO31 8HE
Tel 01904 72 5670
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-----Original Message-----
From: Gary Mascall [mailto:[log in to unmask]]
Sent: 31 May 2005 10:56
To: [log in to unmask]
Subject: Bisphosphonates andHypocalcaemia
A patient with Ca Prostate was given monthly infusions of Bisphosphonates
not for Hypercalcaemia, but to reduce his bone pain.
On commencing his Calcium was 2.36, Alk. Phos 133, Potassium 3.4 and
Creatinine 146.
He went for 5 months without further calcium measurements, but when they
were done his Calcium was 1.65, Alk. Phos 267, Potassium 2.9 and Creatinine
211.
GP was going to discuss with oncologist and put patient on oral Calcium,
Magnesium and Vitamin D following the following set of results, Calcium
1.49, Alk. Phos 304, Potassium 3.1, Creatinine 201, Magnesium 0.45. Patient
now complaining of cramps and muscle weakness, and can't walk down the
corridor to GP's consulting room.
Most recent results similar, Calcium 1.67, Alk. Phos 294, Potassium 3.3,
Creatinine 132, Magnesium 0.46.
BNF suggests check for hypocalcaemia before start treatment, but can't find
anything about how long it will take to rectify this medically induced set
of abnormal Biochemistry results. I don't think it will be a quick fix
cure, especially if they continue with the monthly infusions.
Has anyone else seen this before, if so any advice on timescales would be
welcome.
Regards,
Gary
G.C. Mascall
Clinical Biochemistry Department
Kidderminster & Redditch
Worcestershire
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