Refractory Shock Secondary to Denosumab-induced Severe Hypocalcaemia.

Abstract

Denosumab is a commonly used antiresorptive drugs for the treatment of osteoporosis and to prevent skeletal-related events in patients with cancer.A common side effect of denosumab is hypocalcaemia; conditions associated with a higher risk of hypocalcaemia include chronic kidney disease, pre-existing hypocalcaemia, and metastatic cancer.Severe hypocalcaemia may induce cardiovascular manifestations such as hypotension, bradycardia, impaired cardiac contractility, impaired vascular tone, and arrhythmias.Shock results from diminished vascular smooth muscle tone and tends to occur with rapid severe hypocalcaemia; it is usually refractory to fluid and pressor therapy until hypocalcaemia is corrected.