Abstract
Calcinosis cutis is a known but rare complication from the extravasation of intravenous calcium preparations. Calcium gluconate is a commonly used medication to prevent cardiac arrhythmias in the setting of hyperkalemia and cardiac arrest during resuscitation and life support. Extravasation of calcium gluconate may result in skin necrosis and a bullous reaction in its most severe form, which should be promptly recognized so that treatment can be provided. Pediatric patients are more susceptible to this caustic effect while cases in adults are rare. We report the case of a patient who developed bullous skin lesions with skin necrosis and eschar formation after receiving intravenous calcium gluconate for the treatment of hyperkalemia. The patient required an extensive hospital stay and multiple surgical interventions. This case demonstrates that common medications such as calcium gluconate can lead to significant adverse effects that can be mitigated with proper administration and appropriate education about adverse events.
Highlights
Intravenous calcium gluconate is a medication used to prevent cardiac arrhythmias in the setting of hyperkalemia and cardiac arrest during resuscitation and life support [1]
Extravasation of calcium gluconate may result in skin necrosis and a bullous reaction in its most severe form, which should be promptly recognized so that treatment can be provided
We report the case of a patient who developed bullous skin lesions with skin necrosis and eschar formation after receiving intravenous calcium gluconate for the treatment of hyperkalemia
Summary
Intravenous calcium gluconate is a medication used to prevent cardiac arrhythmias in the setting of hyperkalemia and cardiac arrest during resuscitation and life support [1]. We report the case of a patient who developed bullous skin lesions with necrosis and eschar formation a few hours after receiving calcium gluconate for the treatment of hyperkalemia. The patient was treated conservatively with calcium gluconate, insulin, and intravenous fluids He was later treated with loop diuretics resulting in the resolution of his hyperkalemia and acute kidney injury. Direct immunofluorescence was negative for immune deposits, which ruled out autoimmune bullous disease This finding was attributed to calcium gluconate extravasation causing local calcinosis cutis. His course became complicated as he was discharged from the hospital when his other ailments improved and he was nonadherent with his therapy at home He presented to the primary care clinic three weeks later with wound progression and slough formation with eschar (Figure 3). Hematoxylin and eosin stain of left upper extremity excisional biopsy demonstrating focal gangrenous necrosis and mixed acute and chronic inflammation
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call