Journal
INTERNAL MEDICINE JOURNAL
Volume 35, Issue 12, Pages 726-728Publisher
BLACKWELL PUBLISHING
DOI: 10.1111/j.1445-5994.2005.00949.x
Keywords
hypocalcaemia; bisphosphonate; pamidronate; zoledronate; multiple myeloma
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We report three cases of severe hypocalcaemia associated with i.v. bisphosphonate treatment in patients with multiple myeloma. All patients had symptomatic hypocalcaemia, including a tonic-clonic seizure and tachyarrhythmia in one case. Two cases were associated with the development of acute renal failure, whereas the third patient had pre-existing renal impairment. We recommend that bisphosphonates be used with caution in patients with myeloma and renal impairment, that vitamin D deficiency be corrected prior to treatment (to reduce the risk of hypocalcaemia) and that serum calcium and renal function be monitored during treatment.
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