A Case of Severe, Prolonged, Refractory Hypophosphatemia After Zoledronic Acid Administration

Zoledronic acid (ZA) administration has been associated with electrolyte abnormalities, including hypocalcemia, hypomagnesemia, hypokalemia, and hypophosphatemia. We describe a case of severe, refractory hypophosphatemia in a patient who received ZA for hypercalcemia of malignancy (HCM). Little data...

Full description

Saved in:
Bibliographic Details
Published in:Journal of pharmacy practice 2016-04, Vol.29 (2), p.172-176
Main Authors: Clark, Sarah L., Nystrom, Erin M.
Format: Article
Language:English
Subjects:
Bone Density Conservation Agents - adverse effects
Diphosphonates - adverse effects
Diphosphonates - therapeutic use
Humans
Hypercalcemia - drug therapy
Hypophosphatemia - chemically induced
Imidazoles - adverse effects
Imidazoles - therapeutic use
Male
Middle Aged
Paraneoplastic Syndromes - drug therapy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Zoledronic acid (ZA) administration has been associated with electrolyte abnormalities, including hypocalcemia, hypomagnesemia, hypokalemia, and hypophosphatemia. We describe a case of severe, refractory hypophosphatemia in a patient who received ZA for hypercalcemia of malignancy (HCM). Little data are available that describe the incidence or degree of severity of hypophosphatemia that can occur following ZA administration. In addition, no formal recommendations exist to guide monitoring for or management of electrolyte derangements in the setting of bisphosphonate use. Our patient required daily, high-dose phosphorus replacement beginning day 4 following ZA administration. The average daily dose of phosphorus, including both intravenous and enteral administration, was highest in the first 2 weeks after ZA, averaging 77 mmol/d days 4 through 15, and does not include sources of phosphorus from the patient’s nutrition support. Despite this high amount of supplementation, which was well beyond what meets normal daily requirements and the amount expected to treat “usual” hypophosphatemia, the patient did not achieve sustained normal serum phosphorus levels for over 30 days after ZA. ZA is a favorable option for treating HCM because of its longer duration of action, potent serum calcium-lowering effects, and favorable safety profile. The risk of hypophosphatemia with ZA use is reviewed.
ISSN:0897-1900
1531-1937
DOI:10.1177/0897190015624050