Aubery,

I couldn't understand how you made a decisive
diagnosis of vitamin D deficiency in this patient?
My simple explanation is bisphosphonate induced
hypomagnesaemia leading to hypocalcaemia and
hypokalaemia. I must be missing some obvious
pathophysiology and would therefore be grateful for
further explanation.

Best wishes

Mohammad


--- [log in to unmask] wrote:
> Not uncommon. He will have Vitamin D deficiency.
> Ca Prostate is also a common scenario where this
> happens more commonly (osteoblastic mets). Suggest
> they give him a decent amount of Vitamin D (usual
> oral supplements are homeopathic) such as imi
> calciferol 300,000 Units IMI, as well as oral
> supplements (high dose oral D if locally
> obtainable). Check his plasma 25(OH)D before
> administering for the record.
> 
> Sounds as if he should be in hospital for some iv
> magnesium/Ca/K until he gets over his immediate
> problems.
> 
> Aubrey
> 
> -- 
> /\=========================================
> || Dr Aubrey Blumsohn
> || Senior Lecturer in Metabolic Bone Disease
> || Bone Metabolism Laboratory
> || Human Nutrition Unit
> || Division of Clinical Sciences (NGHT)
> || Clinical Sciences Centre
> || Northern General Hospital, Herries Road
> || Sheffield S5 7AU, England
> || Email: [log in to unmask]
> || Tel: 114-2715963(office)
> || Fax: 0114 261 8775 (fax)
> \/=========================================
> 
> GM> A patient with Ca Prostate was given
> GM> monthly infusions of Bisphosphonates
> GM> not for Hypercalcaemia, but to reduce his bone
> pain.
> GM> On commencing his Calcium was 2.36, Alk.
> GM> Phos 133, Potassium 3.4 and
> GM> Creatinine 146.
> GM> He went for 5 months without further
> GM> calcium measurements, but when they
> GM> were done his Calcium was 1.65, Alk. Phos
> GM> 267, Potassium 2.9 and Creatinine
> GM> 211.
> GM> GP was going to discuss with oncologist
> GM> and put patient on oral Calcium,
> GM> Magnesium and Vitamin D following the
> GM> following set of results, Calcium
> GM> 1.49, Alk. Phos 304, Potassium 3.1,
> GM> Creatinine 201, Magnesium 0.45. Patient
> GM> now complaining of cramps and muscle
> GM> weakness, and can't walk down the
> GM> corridor to GP's consulting room.
> GM> Most recent results similar, Calcium
> GM> 1.67, Alk. Phos 294, Potassium 3.3,
> GM> Creatinine 132, Magnesium 0.46.
> GM> BNF suggests check for hypocalcaemia
> GM> before start treatment, but can't find
> GM> anything about how long it will take to
> GM> rectify this medically induced set
> GM> of abnormal Biochemistry results. I don't
> GM> think it will be a quick fix
> GM> cure, especially if they continue with
> GM> the monthly infusions.
> GM> Has anyone else seen this before, if so
> GM> any advice on timescales would be
> GM> welcome.
> 
> GM> Regards,
> GM> Gary
> 
> GM> G.C. Mascall
> GM> Clinical Biochemistry Department
> GM> Kidderminster & Redditch
> GM> Worcestershire
> 
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> 
> Regards
> 
> Aubrey Blumsohn
> 
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Dr. M A Al-Jubouri
Consultant Chemical Pathologist


	
	
		
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