IATROGENIC HYPERCALCEMIA INDUCED PANCREATITIS FOLLOWING TREATMENT OF OCCULT CALCIUM CHANNEL BLOCKAGE

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Calcium channel blockers are a mainstay for treatment of hypertension.Hypercalcemia is a relatively rare condition with up to 80 % accounting from primary hyperparathyroidism and malignancy but limited literature is seen as a complication of intravenous calcium infusion [1].This case discusses hypercalcemia induced pancreatitis after infusion of calcium for calcium channel blocker overdose.Supportive care and aggressive hydration corrected the metabolic abnormalities and the patient survived. CASE PRESENTATION: A 57 year old gentleman who after intentionally ingesting amlodipine presented with overdose symptomology.His QTc (Corrected QT) was 525 ms (millisecond) on admission, he was treated with calcium intravenous infusion and subsequently his QTc narrowed to 393 ms and also developed iatrogenic pancreatitis.Serum calcium levels were not checked during the infusion.He was treated with supportive care which led to the normalization of serum calcium level and favorable outcome. DISCUSSION: The overuse of CCB can lead arterial vasodilation resulting in hypotension and bradycardia.A study investigated dosage of calcium administration.The authors utilized a loading dose of 0.6 ml kg–1 of 10% calcium gluconate and infusion of 0.6–1.6 ml/kg/hour titrated to hemodynamic parameters and a serum ionized calcium up to two times the upper limit of the reference range [2].One case report demonstrated a calcium level of 32.3 mg/DL that induced iatrogenic pancreatitis leading to anuric kidney injury that required continuous renal replacement therapy but ultimately succumbed to his injuries [3].In our case, after consultation with regional poison control, we opted to use 20 grams of calcium gluconate as there is no set standard of dosage. CONCLUSIONS: Further studies are required regarding how frequently calcium levels should be checked during infusions. Reference #1: Lafferty, F.W.Differential diagnosis of hypercalcemia.J Bone Miner Res, 6: S51-S59.1991.doi:10.1002/jbmr.5650061413 Reference #2: Kerns W II.Management of beta-adrenergic blocker and calcium channel antagonist toxicity.Emerg Med Clin North Am 2007; 25: 309–31.Doi: 10.1016/j.emc.2007.02.001 Reference #3: Sim MT, Stevenson FT.A fatal case of iatrogenic hypercalcemia after calcium channel blocker overdose.J Med Toxicol 2008;4:25–9. DISCLOSURES: No relevant relationships by Apurwa Karki, source=Web Response No relevant relationships by Salman Khan, source=Web Response No relevant relationships by Imran Khan, source=Web Response No relevant relationships by Kim Norville, source=Web Response No relevant relationships by Faraz Siddiqui, source=Web Response