Precipitous Fall in Serum Calcium, Hypotension, and Acute Renal Failure After Intravenous Phosphate Therapy for Hypercalcemia
Authors: STANLEY SHACKNEY
Journal: Annals of Internal Medicine (1967)

Article1 May 1967Precipitous Fall in Serum Calcium, Hypotension, and Acute Renal Failure After Intravenous Phosphate Therapy for HypercalcemiaReport of Two CasesSTANLEY SHACKNEY, M.D., JACK HASSON, M.D.STANLEY SHACKNEY, M.D., JACK HASSON, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-5-906 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a search for more effective forms of therapy for hypercalcemia, Goldsmith and Ingbar (1) have recently focused on the use of oral or parenteral phosphate. They reported a series of 20 hypercalcemic patients in whom phosphate safely lowered the serum calcium. Subsequently, two additional patients were reported in whom transient hypocalcemia was observed after intravenous phosphate infusion; caution with this form of therapy was advised (2).We wish to extend this note of caution further, in view of the precipitous decrease in serum calcium associated with hypotension and acute renal failure after therapy with intravenously administered phosphate buffer in...References1. GOLDSMITHINGBAR RSSH: Inorganic phosphate treatment of hypercalcemia of diverse etiologies. New Eng. J. Med. 274: 1, 1966. CrossrefMedlineGoogle Scholar2. GOLDSMITHINGBAR RSSH: Hyper- to hypocalcemia. Ibid., p. 284. Google Scholar3. HEBERTLEMANNPETERSONLENNON LAJJREJ: Studies of the mechanism by which phosphate infusion lowers serum calcium (abstract). Clin. Res. 14: 349, 1966. Google Scholar4. HYDEJONESMCSWINEYPRUNTY RDRVRRFT: Investigation of hyperparathyroidism in the absence of bone disease. Lancet 1: 250, 1960. CrossrefMedlineGoogle Scholar5. THOMPSONHIATT DDHH: Renal reabsorption of phosphate in normal human subjects and in patients with parathyroid disease. J. Clin. Invest. 36: 550, 1957. CrossrefMedlineGoogle Scholar6. SHACKNEYHASSON SEJ: Unpublished observations. Google Scholar7. BINGER C: Toxicity of phosphates in relation to blood calcium and tetany. J. Pharmacol. Exp. Ther. 10: 105, 1917-18. Google Scholar8. SOFFERTORIBARAMOORE-JONESWEBER ATDD: Clinical applications and untoward reactions of chelation in cardiac arrhythmias. Arch. Intern. Med. (Chicago) 106: 824, 1960. CrossrefGoogle Scholar9. SURAWICZMACDONALDKALJOTBETTINGER BMGVJC: Treatment of cardiac arrhythmias with salts of ethylenediamine tetraacetic acid (EDTA). Amer. Heart J. 58: 493, 1959. CrossrefMedlineGoogle Scholar10. LOWNBLACKMOORE BHFD: Digitalis, electrolytes and the surgical patient. Amer. J. Cardiol. 6: 309, 1960. CrossrefMedlineGoogle Scholar11. BUNKERSTETSONCOEGRILLOMURPHY JPJBRCHAJ: Citric acid intoxication. JAMA 157: 1361, 1955. CrossrefMedlineGoogle Scholar12. MAXWELLELLIOTROBERTSON GMRBE: The effect of Na3-EDTA-induced hypocalcemia upon the general and coronary hemodynamics of the intact animal. Amer. Heart J. 66: 82, 1963. CrossrefMedlineGoogle Scholar13. ROSENBAUMRAMIREZSAMUELSBRESTMOYER JLOSANJH: Effect of sudden blood calcium depletion on phosphorus excretion. Endocrinology 74: 266, 1964. CrossrefMedlineGoogle Scholar14. HENLEY RB: Management of the parathyroid crisis. Amer. J. Surg. 108: 183, 1964. CrossrefMedlineGoogle Scholar15. ALBRIGHTREIFENSTEIN FEC: The parathyroid glands and metabolic bone disease. The Williams & Wilkins Co., Baltimore, 1948, pp. 103ff. Google Scholar16. HELLSTRÖMIVEMARK JBI: Primary hyperparathyroidism. Clinical and structural findings in 138 cases. Acta Chir. Scand. 294 (suppl.): 1, 1962. Google Scholar17. BULGERDIXONBARRSCHREGARDUS HAHHDPO: The functional pathology of hyperparathyroidism. J. Clin. Invest 9: 143, 1930-31. CrossrefMedlineGoogle Scholar18. DENT CE: Some problems of hyperparathyroidism. Brit. Med. J. 1: 1419, 1962. CrossrefGoogle Scholar19. MIKIYOSHIKAWATAKADAFUJITAMORII ISSTH: A case of primary hyperparathyroidism with parathyroid hormone assay in urine and adenoma tissue. Acta Endocr. (Kobenhavn) 43: 161, 1963. MedlineGoogle Scholar20. SEIFENFLACKEALPER EWMH: Effects of calcium on isolated mammalian heart. Amer. J. Physiol. 207: 716, 1964. CrossrefMedlineGoogle Scholar21. LOWNCANER BEZ, cited by LOWN, B., BLACK, H., MOORE, F. D.: Digitalis, electrolytes and the surgical patient. Amer. J. Cardiol. 6: 309, 1960. CrossrefMedlineGoogle Scholar22. FIRTHEJHAL PL: Treatment of severe hemorrhage. Lancet 273: 1132, 1957. CrossrefMedlineGoogle Scholar23. BOHR DF: Electrolytes and smooth muscle contraction. Pharmacol. Rev. 16: 85, 1964. MedlineGoogle Scholar24. WAUGH WH: Role of calcium in contractile excitation of vascular smooth muscle by epinephrine and potassium. Circ. Res. 11: 927, 1962. CrossrefMedlineGoogle Scholar25. BRIGGSMELVIN AHS: Ion movements in isolated aortic strips. Amer. J. Physiol. 201: 365, 1961. CrossrefGoogle Scholar26. FROHLICHSCOTTHADDY EDJBFJ: Effect of cations on resistance and responsiveness of renal and forelimb vascular beds. Amer. J. Physiol. 203: 583, 1962. CrossrefMedlineGoogle Scholar27. OVERBECKMOLNARHADDY HWJIFJ: Resistance to blood flow through the vascular bed of the dog forelimb. Local effects of sodium, calcium, magnesium, acetate, hypertonicity and hypotonicity. Amer. J. Cardiol. 8: 533, 1961. CrossrefMedlineGoogle Scholar28. MOORESMITH WTLH: Experience with a calcium infusion test in parathyroid disease. Metabolism 12: 447, 1963. Google Scholar29. EARLLKURTZMANMOSER JMNARH: Hypercalemia and hypertension. Ann. Intern. Med. 64: 378, 1966. LinkGoogle Scholar30. THOMASWISWELLCONNORHOWARD WCJGTBJE: Hypercalcemic crisis due to hyperparathyroidism. Amer. J. Med. 24: 229, 1958. CrossrefMedlineGoogle Scholar31. COPE O: Hyperparathyroidism: diagnosis and management. Amer. J. Surg. 99: 394, 1960. CrossrefMedlineGoogle Scholar32. HELLSTRÖMBIRKEEDVALL JGCA: Hypertension in hyperparathyroidism. Brit. J. Urol. 30: 13, 1958. CrossrefMedlineGoogle Scholar33. DOUGLASRUBIN WWRP: The role of calcium in the secretory response of the adrenal medulla to acetylcholine. J. Physiol. (London) 159: 40, 1961. CrossrefGoogle Scholar34. BURNGIBBONS JHWR: The part played by calcium in determining the response to stimulation of sympathetic postganglionic fibres. Brit. J. Pharmacol. 22: 540, 1964. Google Scholar35. SKJÖRTEN F: Bilateral renal cortical necrosis and the generalized Shwartzman reaction. 1. Review of literature and report of seven cases. Acta Path. Microbiol. Scand. 61: 394, 1964. CrossrefMedlineGoogle Scholar36. SHEEHANMOORE HLHC: Renal Cortical Necrosis and the Kidney of Concealed Accidental Hemorrhage. Charles C Thomas, Publisher, Springfield, Ill., 1953. Google Scholar37. STRAUSSWELT MBLG: Diseases of the Kidney. Little, Brown and Co., Boston, 1963, pp. 526-539. Google Scholar38. MCKAYJEWETTREID DGJFDE: Endotoxin shock and the generalized Shwartzman reaction in pregnancy. Amer. J. Obstet. Gynec. 78: 546, 1959. CrossrefGoogle Scholar39. BAERNEU LHC: Intravascular clotting and acute pancreatitis in primary hyperparathyroidism. Ann. Intern. Med. 64: 1062, 1966. LinkGoogle Scholar40. ARNOLD W: Epithelkörperchentumor mit allgemeiner calcinose. Virchow. Arch. Path. Anat. 306: 427, 1940. CrossrefGoogle Scholar41. MELLGREN J: Acute fatal hyperparathyroidism. Acta Path. Microbiol. Scand. 20: 693, 1943. CrossrefGoogle Scholar42. HENRIKSSON C: Acute hyperparathyroidism and acute pancreatitis. Acta Path. Microbiol. Scand. 50: 42, 1960. CrossrefMedlineGoogle Scholar43. HEUPER W: Metastatic calcifications in the organs of the dog after injections of parathyroid extract. Arch. Path. (Chicago) 3: 14, 1927. Google Scholar44. SHACKNEYHASSON SEJ: Unpublished observations Google Scholar45. HADDYSCOTTFLORIODAUGHERTYHUIZENGA FJJBMARMJN: Local vascular effects of hypocalcemia, alkalosis, hypercalcemia, and hypomagnesemia. Amer. J. Physiol. 204: 202, 1963. CrossrefMedlineGoogle Scholar46. DENT CE: Some problems of hyperparathyroidism. Brit. Med. J. 1: 1495, 1962. CrossrefGoogle Scholar47. ALBRIGHTBAUERCLAFLINCOCKRILL FWDJR: The effect of phosphate ingestion in clinical hyperparathyroidism. J. Clin. Invest. 11: 411, 1932. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: St. Louis, MissouriFrom the Departments of Medicine and Pathology, The Jewish Hospital of St. Louis and Washington University School of Medicine, St. Louis, Mo.Requests for reprints should be addressed to Stanley Shackney, M.D., National Cancer Institute, Wiscon Bldg., Room 3C12, National Institutes of Health, Bethesda, Md. 20014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByDrug-induced hypophosphatemiaNutritional hypophosphatemic rickets secondary to Neocate® useAn Alternative Approach to Treatment of Hypophosphatemia in Nonsurgical Critically Ill Patients in Countries With Limited ResourcesAggressive Treatment of Life-Threatening Hypophosphatemia During Recovery From Fulminant Hepatic Failure: A Case ReportUsing phosphate supplementation to reverse hypophosphatemia and phosphate depletion in neurological disease and disturbanceHypercalcemia in the Intensive Care UnitPhoxilium vs Hemosol-B0 for continuous renal replacement therapy in acute kidney injurySevere hypercalcemic hyperparathyroidism developing in a patient with hyperaldosteronism and renal resistance to parathyroid hormoneSymptomatic Primary Hyperparathyroidism Medical TherapyPlasma Calcium and Risk of Hypertension: Propensity Score Analysis Using Data From the Korean Genome and Epidemiology StudyPhase III clinical trial of OPF-102 in renal failure patientsAdverse Renal and Metabolic Effects Associated with Oral Sodium Phosphate Bowel PreparationOral sodium phosphate bowel purgatives and acute phosphate nephropathyHypophosphatemia: Clinical Consequences and ManagementHypophosphatemia: an evidence-based approach to its clinical consequences and managementHypercalcaemic crisis and squamous carcinoma of the renal pelvisThe effects of serum calcium and parathyroid hormone and the interaction between them on blood pressure in normal subjects and in patients with chronic kidney failureEndocrine paraneoplastic syndromes in lung cancerPhosphorus-Enriched Hemodialysates: Formulations and Clinical UseAcute Management of HypercalcemiaPrevention of hypercalcaemic nephropathy and tissue calcification by glucagon during phosphate infusionHypophosphataemiaPathophysiology, effects and management on the intensive care unitManagement of tumor lysis syndrome with standard continuous arteriovenous hemodialysis: case report and a review of the literatureEfficacy and Safety of Intravenous Phosphate Replacement in Critically Ill PatientsEndokrines SystemTreatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing schemeIntravenous phosphate repletion regimen for critically ill patients with moderate hypophosphatemiaThe effect of graded calcium infusions on rhythmic blood pressure oscillations in normal manDrug Therapy of Hypercalcemia Due to MalignancyHypophosphatemia and Hemolytic Anemia Associated With Diabetes Mellitus and Hepatic Lipidosis in CatsManagement of Acute HypercalcemiaManagement of hyperparathyroid patients with grave hypercalcemiaToxic Effects of Electrolyte and Trace Mineral Administration in the Intensive Care UnitHypercalcemia of malignancy: pathophysiology, diagnosis and treatmentManagement of Severe HypercalcemiaEndokrines SystemPhosphate excess and progressive renal failure: The precipitation-calcification hypothesisTreatment of HypercalcemiaPhysiological mechanisms for calcium-induced changes in systemic arterial pressure in stable dialysis patients.Verapamil reverses calcium cardiotoxicityTherapy of hypercalcemia of malignancyAMINOHYDROXYPROPYLIDENE DIPHOSPHONATE TREATMENT OF HYPERCALCEMIC CRISIS DUE TO PRIMARY HYPERPARATHYROIDISMEndokrines SystemA single-day treatment of tumor-induced hypercalcemia by intravenous amino-hydroxypropylidene bisphosphonateCOMPARISON OF INTRAVENOUS (3-AMINO-1-HYDROXYPROPYLIDENE)-1, 1-BISPHOSPHONATE AND VOLUME REPLETION IN TUMOUR-INDUCED HYPERCALCAEMIADrug-Induced Electrolyte DisordersHypophosphatemiaDisorders of calcium and magnesium homeostasisAcute hypercalcemic hypertension in man: Role of hemodynamics, catecholamines, and reninHyperparathyroid crisis and acute necrotizing pancreatitis presenting as diabetic ketoacidosisAcute tumor lysis syndromeRenal failure due to tumor-induced hypercalcaemea: mechanisms and treatmentTreatment of Severe HypophosphatemiaRICHARD D. LENTZ, M.S., M.D., DAVID M. BROWN, M.D., CARL M. KJELLSTRAND, M.D.ParathyreoideaDisorders of Mineral Metabolism in MalignancyStimulation of bone formation in vivo by phosphate supplementationManagement of Complications in the Course of Malignant DiseaseCalcium homeostasis and the pathogenesis and management of hypercalcemic disordersParaproteinämische HämoblastosenThe ParathyroidsPulmonary Calcification in a Patient with Multiple MyelomaComa in an infant due to hypertonic sodium phosphate medicationThe Spectrum of Drug-Induced Pulmonary DiseaseE. C. ROSENOW III, M.D., F.A.C.P.Minerals in Total Parenteral NutritionTumor-Induced HypercalcemiaBlood Pressure Effects of Acute Hypercalcemia Studies in Patients with Chronic Renal FailurePETER WEIDMANN, M.D., SHAUL G. MASSRY, M.D., JACK W. COBURN, M.D., F.A.C.P., MORTON H. MAXWELL, M.D., F.A.C.P., JOYCE ATLESON, R.N., CHARLES R. KLEEMAN, M.D., F.A.C.P.CALCITONIN IN THE TREATMENT OF HYPERCALCAEMIC CRISISAcute Treatment of Hypercalcemia with FurosemideHypercalcemia Associated with Neoplastic DiseaseFRANCO M. MUGGIA, M.D., HENRY O. HEINEMANN, M.D., F.A.C.P.Phosphatbehandlung bei Hypercalc�mieEffect of Intravenous Phosphate on Serum Strontium and CalciumThe Clinical Problem of Primary HyperparathyroidismMithramycin treatment of hypercalcemiaInorganic Phosphates in the Treatment of HypercalcemiaComplicationsRenal Complications of LymphomaJOSEPH M. KIELY, M.D., F.A.C.P., RICHARD D. WAGONER, M.D., F.A.C.P., KEITH E. HOLLEY, M.D.Hypercalcemic crisis in acute leukemiaSo-called "metastatic" calcification of the lungRenal Excretion of Alkaline Earths**These studies have been supported by the National Institutes of Health (AM-02306 and GM-K3-2583).Hypercalcemic crisis treated with inorganic phosphate solutionA case of acute hyperparathyroidism, with thyrotoxicosis and pancreatitis, presenting as hyperemesis gravidarum.Central Nervous System Manifestations of Fluid and Electrolyte DisturbancesPHOSPHATE FOR HYPERCALCEMIAO. BETTER, J. SHARF, J. HEMLI, S. BRANDSTAETTEREmergency Treatment of HypercalcæmiaHypernatremia during Sodium Sulfate Therapy 1 May 1967Volume 66, Issue 5Page: 906-916KeywordsAcute renal failureCalciumFallsHospital medicineHypercalcemiaHypocalcemiaHypotensionNecrosisOral medicinePhosphates Issue Published: 1 May 1967 PDF DownloadLoading ...