SHM Converge Scientific Abstract ePoster Gallery-Profound Delayed Hypercalcemia as a Complication of Rhabdomyolysis and Acute Kidney Injury

Pdf Summary

This case report describes a rare complication of rhabdomyolysis with acute kidney injury: profound delayed hypercalcemia. A 76-year-old man had been hospitalized eight weeks earlier for rhabdomyolysis and renal failure requiring dialysis. During that admission, he developed hypocalcemia that needed aggressive calcium replacement. Two weeks before the current admission, his creatinine had normalized.<br /><br />He later returned from a skilled nursing facility with altered mental status and weakness. On admission, his creatinine was mildly elevated at 1.4, but his corrected calcium was extremely high at 20.9 mg/dL, with ionized calcium above the detection threshold. Laboratory evaluation showed suppressed parathyroid hormone, with normal PTHrP, ACE, and vitamin D levels, making common endocrine and malignancy-related causes unlikely.<br /><br />His calcium initially improved with intravenous fluids, diuresis, and four doses of calcitonin, but then plateaued, prompting treatment with denosumab. During the hospitalization, CT chest performed for hypoxia incidentally revealed diffuse calcifications in skeletal muscle. Review of the prior admission also found calcinosis cutis of the right arm, confirmed by biopsy showing diffuse dermal calcification with Von Kossa staining.<br /><br />The authors concluded that the hypercalcemia was caused by delayed mobilization of calcium stored in soft tissue deposits after rhabdomyolysis and AKI, likely worsened by prior calcium supplementation and deconditioning. His calcium normalized by hospital day 22 after additional denosumab, and his mental status returned to baseline.<br /><br />The report highlights the typical calcium pattern in rhabdomyolysis with AKI: early hypocalcemia during the oliguric phase, followed by later hypercalcemia when calcium is released from tissue deposits. Imaging or exam findings of soft tissue calcification can support the diagnosis. Treatment may include fluids, loop diuretics, calcitonin, denosumab, or bisphosphonates, though calcitonin may fail due to tachyphylaxis.

Asset Subtitle

Andrew R. Lai

Meta Tag

Author List Andrew R. Lai, Ayush Kumar, Molly A. Kantor, Yoo Jin (Eunice) Lee

Category Clinical Vignettes

Concept Rhabdomyolysis

Concept Calcium Metabolism

Concept Hypercalcemia

Concept Delayed Hypercalcemia

Concept Acute Kidney Injury

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Andrew R. Lai

Track Adult

Keywords

rhabdomyolysis

acute kidney injury

hypercalcemia

calcinosis cutis

soft tissue calcification

denosumab

calcitonin

hypocalcemia

renal failure

calcium mobilization

Rhabdomyolysis

Calcium Metabolism

Hypercalcemia

Delayed Hypercalcemia

Acute Kidney Injury