Severe hypercalcemia following hip joint implantation of calcium sulfate antibiotic beads: case series and review of literature.

Authors

Andrew P. Demidowich, Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
Mahsa Motevalli, Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
Kevin Yi, Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
Atena Kamali, Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
Kristine Batty, Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
Kendall F. Moseley, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Robert Raymond Buber, OrthoBethesda, 10215 Fernwood Rd #506, Bethesda, MD, USA
Mehdi Hashemipour`, George Washington University, School of Engineering and Applied Science, Washington, DC, USA
Mihail Zilbermint, Suburban Hospital, Department of Medicine, Bethesda, MD, USAFollow

Abstract

Purpose: The diagnosis and management of hypercalcemia in hospitalized patients can be challenging. Hypercalcemia is often associated with significant morbidity and end-organ damage which may delay a patient’s recovery.

Methods: We report a case series of three patients who underwent orthopedic procedures with intraoperative placement of vancomycin-loaded calcium sulfate beads. Patients had no known history of malignancy or excess intake of calcium, vitamin A or vitamin D. Laboratory workup showed low parathyroid (PTH) levels and normal PTH-related peptide levels. The temporal nature of the non-PTH mediated hypercalcemia in relation to implantation of the antibiotic beads suggests causality of exogenous calcium sulfate with the patients’ subsequent hypercalcemia.

Results: Patients were treated with aggressive intravenous saline and zoledronic acid resulting in resolution of hypercalcemia in all cases. The antibiotic impregnated beads did not require explantation.

Conclusion: Hypercalcemia following calcium sulfate antibiotic bead implantation may contribute to patient morbidity and increased length-of-stay. We recommend serum calcium and creatinine be closely monitored during the early post-operative period in patients who receive calcium sulfate antibiotic beads.

Recommended Citation

Demidowich, Andrew P.; Motevalli, Mahsa; Yi, Kevin; Kamali, Atena; Batty, Kristine; Moseley, Kendall F.; Buber, Robert Raymond; Hashemipour`, Mehdi; and Zilbermint, Mihail () "Severe hypercalcemia following hip joint implantation of calcium sulfate antibiotic beads: case series and review of literature.," Journal of Community Hospital Internal Medicine Perspectives: Vol. 15: Iss. 1, Article 23.
DOI: 10.55729/2000-9666.1449
Available at: https://scholarlycommons.gbmc.org/jchimp/vol15/iss1/23