Hypercalcemia in a 67-Year-Old Female Following the Use of Calcium Sulfate Beads: A Case Report and Review of Literature.

Hussam R Alkaissi,Samy I Mcfarlane

doi:10.7759/cureus.21671

Abstract

While the milk-alkali syndrome is traditionally viewed as the sole cause of exogenous hypercalcemia, the wide use of calcium sulfate (CS) in orthopedic procedures introduced another important item to be considered in the differential diagnosis. Calcium sulfate beads are increasingly used as void fillers and prophylactic measures to prevent postoperative hardware infections. However, hypercalcemia secondary to rapid calcium absorption from calcium sulfate beads is generally an underrecognized adverse effect and likely underreported. Furthermore, with calcium sulfate beads, hypercalcemia can dramatically present with alteration in mental status. In this report, we present a case of a 67-year-old female who underwent two orthopedic procedures, where calcium sulfate beads were used in both. The patient, on both occasions, developed significant hypercalcemia, manifested as agitation and suicidal thoughts, with each episode resolving after proper hydration and lowering of serum calcium. Also, in this report, we examined the literature and highlighted the female predominance in the reported cases, often manifesting in postoperative day (POD) 4. Given the acuity and severity of hypercalcemia, it is paramount to anticipate hypercalcemia, monitor serum calcium postoperatively to allow timely interventions, and avoid potentially serious complications.

Highlights

Calcium sulfate (CS) beads are increasingly used in orthopedic procedures as a void filler and a mode of delivering high concentrations of antibiotics locally to prevent postsurgical hardware infection
A 67-year-old female with a right-sided total hip replacement presented with right hip pain following a mechanical fall
Earlier detection led to earlier proper hydration; the patient was asymptomatic, and calcium level normalized on postoperative day 8, down to 10.1 mg/dL

Summary

Introduction

Calcium sulfate (CS) beads are increasingly used in orthopedic procedures as a void filler and a mode of delivering high concentrations of antibiotics locally to prevent postsurgical hardware infection. Since they are readily absorbable, they can cause transient hypercalcemia [1,2]. On postoperative day (POD) 4, the patient had a panic attack with suicidal ideation She had no dyspnea, chest or abdominal pain, or polyuria. Dashed line: normal range of calcium level, between 8.5 and 10.4 mg/dL; gray line: days receiving intravenous hydration for symptomatic hypercalcemia (postoperative day 4 to 11). Earlier detection led to earlier proper hydration; the patient was asymptomatic, and calcium level normalized on postoperative day 8, down to 10.1 mg/dL

Discussion

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Disclosures

Dreesmann H