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Rastegar M, Levine BS, Felsenfeld AJ. Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism. Clin Kidney J. 2014;7(3):299-302doi: 10.1093/ckj/sfu041.
Rastegar, M., Levine, B. S., & Felsenfeld, A. J. (2014). Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism. Clinical kidney journal, 7(3), 299-302. https://doi.org/10.1093/ckj/sfu041
Rastegar, Mandana, et al. "Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism." Clinical kidney journal vol. 7,3 (2014): 299-302. doi: https://doi.org/10.1093/ckj/sfu041
Rastegar M, Levine BS, Felsenfeld AJ. Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism. Clin Kidney J. 2014 Jun;7(3):299-302. doi: 10.1093/ckj/sfu041. Epub 2014 May 09. PMID: 25852894; PMCID: PMC4377759.
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Clin Kidney J. 2014 Jun;7(3):299-302. doi: 10.1093/ckj/sfu041. Epub 2014 May 09.

Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism.

Clinical kidney journal

Mandana Rastegar, Barton S Levine, Arnold J Felsenfeld

Affiliations

  1. Department of Medicine , Greater Los Angeles VA Healthcare System and the David Geffen School of Medicine at UCLA , Los Angeles , CA , USA.

PMID: 25852894 PMCID: PMC4377759 DOI: 10.1093/ckj/sfu041

Abstract

A 58-year-old man with Stage 3b chronic kidney disease and primary hyperparathyroidism treated with cinacalcet was admitted for acute cholecystitis. A cholecystostomy tube was placed, estimated glomerular filtration rate decreased, metabolic acidosis developed and ionized calcium increased from 1.33 to 1.76 mM despite cinacalcet administration. A sodium bicarbonate infusion corrected the metabolic acidosis restoring ionized calcium to normal despite no improvement in renal function. The correlation between the increase in serum bicarbonate and decrease in ionized calcium was r = -0.93, P < 0.001. In summary, severe hypercalcemia was attributable to metabolic acidosis increasing calcium efflux from bone while renal failure decreased the capacity to excrete calcium.

Keywords: bone; hypercalcemia; metabolic acidosis; primary hyperparathyroidism; renal failure

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