Hypocalcemia drug-related

Pamidronate can cause asymptomatic hypocalcemia (SEDA-20, 440). In a study of the use of pamidronate to treat immobilization hypercalcemia after acute spinal cord injury in nine patients, one patient had transient drug-related fever and four had asymptomatic hypocalcemia (28). 

Hypercalcemia Carefully monitor standard hypercalcemia-related metabolic parameters, such as serum levels of calcium, phosphate, and magnesium, as well as serum creatinine. Do not use loop diuretics until the patient is adequately rehydrated use with caution in combination with zoledronic acid in order to avoid hypocalcemia. Use zoledronic acid with caution with other nephrotoxic drugs. Concomitant use with estrogen/hormone replacement therapy (alendronate) Two clinical studies have shown that the degree of suppression of bone turnover (as assessed by mineralizing surface) was significantly greater with the combination than with either component alone. 

Immunoreactive parathyroid hormone concentrations may be increased by anticonvulsants, while bone mineral content is reduced. Hypocalcemia and osteopenia can occur, despite normal serum concentrations of active vitamin D metabolites, suggesting that they may be independent of drug effects on vitamin D metabolism. Bone biopsies have shown increased osteoid but normal calcification front formation, accelerated rate of mineralization, and reduced mineralization lag time, suggesting increased skeletal turnover rather than osteomalacia (96). The risk of age-related fractures in drug-treated epileptic patients is not greatly increased (97). 

Gallium nitrate is approved for treating cancer-related hypercalcemia. It showed antitumor activity fur putienb with lymphoma in phase II trials. - Gallium nitrate probably works in hypercalcemia by inhibiting calcium resorption from bone, although the precise mechanism is unknown. Major side effects include hypocalcemia and nephrotoxicity. On continuous infusion, the drug exhibits biphasic elimination with an a half-life of 8.3 to 26 minutes and a half-life of 6.3 to 95 hours. Between 69 and 91% of the dnsc was recovered in the urine. ... 

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