Abstract
Hyperkalaemia is a very rare complication associated with zoledronic acid. We report the case of a patient with hyperkalaemia recalcitrant to treatment. A 72 year-old woman who was diagnosed with post-menopausal severe osteoporosis following a bone mineral density scan was treated with a single dose of zoledronic acid infusion. After 3 weeks, the patient’s serum potassium level increased from a baseline of 3.8 mmol/L to 5.9 mmol/L. Renal function was normal and all other possible causes of hyperkalaemia were excluded. She was started on oral sodium polystyrene sulfonate 15 g twice daily. Her serum potassium level remained persistently elevated over the next 9 weeks before it finally returned to a normal level on the 13th week after zoledronic acid infusion. We recommend close monitoring and prompt treatment of hyperkalaemia should it occur.
Highlights
Bisphosphonates are commonly used for the treatment of diseases with excessive bone resorption
We report a second case of hyperkalaemia associated with zoledronic acid use and draw comparisons between the two cases
The patient had a history of ischaemic heart disease and his condition was complicated by cardiac arrest 10 days following the zoledronic acid infusion
Summary
Bisphosphonates are commonly used for the treatment of diseases with excessive bone resorption. While we may be familiar with more common side effects such as renal toxicity, flu-like symptoms (bone pain, arthralgia, fever, nausea, chills), atrial fibrillation and hypocalcaemia, there have been increasing number of case reports describing rare but significant complications associated with zoledronic acid use [5,6] These include osteonecrosis of the jaw, orbital inflammatory disease, transient changes in thyroid function tests, transient hepatotoxicity, flare up of hand osteoarthritis and lifethreatening hyperkalaemia [7,8,9,10,11,12]. As our patient was clinically asymptomatic and had no ECG changes, she was started on oral sodium polystyrene sulfonate 15 g twice daily for the treatment of her hyperkalaemia Her serum potassium level remained persistently elevated over the 9 weeks before it returned to normal level on the 13th week after zoledronic acid infusion (Figure 1)
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