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Oh YI, An JH, Lim GH, Park SM, Kim TH, Seo KW, Youn HY. Pamidronate-induced irreversible symptomatic hypocalcemia in a dog with hypercalcemia after glucocorticoid withdrawal: a case report. BMC Vet Res 2024; 20:227. [PMID: 38790012 PMCID: PMC11127328 DOI: 10.1186/s12917-024-04030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Pamidronate is used for the treatment of hypercalcemia. However, a rare but potential adverse event of pamidronate treatment is hypocalcemia. This report describes an unusual case of severe, irreversible hypocalcemia after a single injection of pamidronate for the treatment of hypercalcemia due to glucocorticoid withdrawal in a dog. CASE PRESENTATION An 11-year-old castrated male Maltese dog presented with anorexia, vomiting, and diarrhea (day 0). The patient had calcinosis cutis throughout the body, calcification of intraabdominal organs, mild azotemia, and severe hypercalcemia. The severe calcification was attributed to long-term glucocorticoid administration, which was discontinued 1 month before presentation. Fluid therapy, diuretics, calcitonin, and a single intravenous injection of pamidronate were used for the treatment of hypercalcemia. On day 14, normocalcemia was achieved, but renal failure occurred. On day 20, severe and irreversible hypocalcemia occurred, and on day 42, the patient was euthanized at the owner's request because of worsened hypocalcemia and renal failure. CONCLUSIONS Although hypocalcemia is an extremely rare adverse event of bisphosphonate treatment, bisphosphonates like pamidronate can result in potentially life-threatening conditions according to the patient's underlying conditions. Therefore, the patient's condition should be closely monitored and any underlying conditions should be carefully evaluated before initiating the treatment for hypercalcemia using pamidronate.
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Affiliation(s)
- Ye-In Oh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine & Institute for Veterinary Biomedical Science, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Ju-Hyun An
- Department of Veterinary Emergency and Critical Care Medicine, Institute of Veterinary Science, College of Veterinary Medicine, Kangwon National University, Chuncheon-si, 24341, Republic of Korea
| | - Ga-Hyun Lim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Su-Min Park
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Tae-Hee Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Kyoung-Won Seo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hwa-Young Youn
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, 08826, Republic of Korea.
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Edwards L, Magdesian KG. Retrospective evaluation of acute kidney injury in horses treated with nonnitrogenous bisphosphonates (2013-2020): 8 cases. J Vet Emerg Crit Care (San Antonio) 2023; 33:685-695. [PMID: 37695208 DOI: 10.1111/vec.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To describe a population of horses with acute kidney injury (AKI) following administration of bisphosphonates including clinical signs, clinicopathologic data, treatment, and outcome. DESIGN Retrospective study from August 2013 to July 2020. SETTING Veterinary university teaching hospital. ANIMALS Eight adult horses with AKI following administration of nonnitrogenous bisphosphonates. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Five horses received intramuscular clodronate (5/8; 62.5%) and 3 horses received intravenous tiludronate (3/8; 37.5%). Six horses (6/8; 75%) received concurrent nonsteroidal anti-inflammatory drugs. The most common initial presenting complaint was poor appetite (6/8; 75%), followed by abnormal urination (2/8; 25%). At the time of initial evaluation, the mean serum or plasma creatinine was 451.72 ± 190.06 μmol/L (5.11 ± 2.15 mg/dL) and BUN was 18.84 ± 8.85 mmol/L (52.75 ± 24.77 mg/dL). Five horses (5/6; 83.3%) had either an increased number of red blood cells (n = 4) or hemoprotein (n = 1) in the urine. All horses were treated with IV isotonic, balanced crystalloids either as a bolus, continuous rate infusion, or a combination of the 2. Seven horses (7/8; 87.5%) survived the initial episode of AKI and 1 horse (1/8; 12.5%) was euthanized. Of the 7 surviving horses, 2 horses (2/7; 28.5%) went on to develop chronic renal dysfunction. Warmblood breeds were overrepresented in the AKI group (P = 0.008; odds ratio: 11.5, 95% confidence interval: 1.8-72.1), when compared to horses that received bisphosphonates during the study period and did not develop AKI. CONCLUSIONS Bisphosphonate administration, with or without concurrent nonsteroidal anti-inflammatory drugs, can be associated with AKI in horses. Serum creatinine should be monitored prior to and following bisphosphonate treatment to minimize this risk. Further evaluation of renal function is warranted in horses that develop clinical signs of poor appetite, lethargy, or altered urination in the days following bisphosphonate treatment.
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Affiliation(s)
- Lisa Edwards
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, California, USA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, University of California, Davis, Davis, California, USA
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Marker BA, Barber LG, Clifford CA, Correa SS, Thalhofer PL, LaDue TA, Mullin CM, Sauerbrey ML, Wood CC. Extravasation reactions associated with the administration of pamidronate: 11 cases (2008-2013). Vet Comp Oncol 2016; 15:470-480. [PMID: 27174040 DOI: 10.1111/vco.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022]
Abstract
Pamidronate is a bisphosphonate drug widely utilized in veterinary oncologic practice for the palliation of malignant osteolysis. Pamidronate has not been previously reported to cause tissue injury upon extravasation in dogs. The medical records of 11 client-owned dogs undergoing palliative treatment for primary bone tumors with known or suspected pamidronate extravasation reactions were reviewed. The majority of adverse events were low grade in nature, however in some cases, the reactions were severe and led to euthanasia in one instance. Time to complete resolution of lesions ranged from within several days to greater than one and a half months. Aside from the dog that was euthanized, no long-term sequelae of extravasation were identified. Treatments employed to address the reactions varied widely. Pamidronate extravasation reaction appears to be an uncommon, but potentially serious complication of intravenous administration.
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Affiliation(s)
- B A Marker
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - L G Barber
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, 01536, USA
| | - C A Clifford
- Red Bank Veterinary Hospital, Tinton Falls, NJ, 07724, USA
| | - S S Correa
- Animal Cancer Care Clinic, Ft. Lauderdale, FL, 33304, USA
| | - P L Thalhofer
- Metropolitan Veterinary Hospital, Akron, OH, 44321, USA
| | - T A LaDue
- Southeast Veterinary Oncology, Orange Park, FL, 32073, USA
| | - C M Mullin
- Red Bank Veterinary Hospital, Tinton Falls, NJ, 07724, USA
| | - M L Sauerbrey
- Oakland Veterinary Referral Services, Bloomfield Hills, MI, 48302, USA
| | - C C Wood
- Veterinary Referral and Emergency Center of Westbury, Westbury, NY, USA
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Chung YS, Kang HC, Lee T. Comparative Effects of Ibandronate and Paclitaxel on Immunocompetent Bone Metastasis Model. Yonsei Med J 2015; 56:1643-50. [PMID: 26446649 PMCID: PMC4630055 DOI: 10.3349/ymj.2015.56.6.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/26/2014] [Accepted: 01/02/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Bone metastasis invariably increases morbidity and mortality. This study compares the effects of ibandronate and paclitaxel on bone structure and its mechanical properties and biochemical turnover in resorption markers using an immunocompetent Walker 256-Sprague-Dawley model, which was subjected to tumor-induced osteolysis. MATERIALS AND METHODS Seventy rats were divided equally into 4 groups: 1) sham group (SHAM), 2) tumor group (CANC), 3) ibandronate treated group (IBAN), and 4) paclitaxel treated group (PAC). Morphological indices [bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp)] and mechanical properties (failure load, stiffness) were evaluated after thirty days of treatment period. Bone resorption rate was analysed using serum deoxypyridinoline (Dpd) concentrations. RESULTS Morphological indices showed that ibandronate (anti-resorptive drug) had a better effect in treating tumor-induced architectural changes in bone than paclitaxel (chemotherapeutic drug). The deterioration in bone architecture was reflected in the biomechanical properties of bone as studied with decreased failure load (F(x)) and stiffness (S) of the bone on the 30th day postsurgery. Dpd concentrations were significantly lower in the IBAN group, indicating successful inhibition of bone resorption and destruction. CONCLUSION Ibandronate was found to be as effective as higher doses of paclitaxel in maintaining stiffness of bone. Paclitaxel treatment did not appear to inhibit osteoclast resorption, which is contrary to earlier in-vitro literature. Emphasis should be placed on the use of immunocompetent models for examining drug efficacy since it adequately reflects bone metastasis in clinical scenarios.
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Affiliation(s)
- Yoon-Sok Chung
- Department of Endocrinology & Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Ho Chul Kang
- Department of Medical Biotechnology, Dongguk University, Seoul, Korea
| | - Taeyong Lee
- Department of Medical Biotechnology, Dongguk University, Seoul, Korea.
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Abstract
Bisphosphonate use has increased in veterinary medicine over the last decade. During this time, bisphosphonate related osteonecrosis of the jaws (BRONJ) in human patients has been identified. Only recently was a dog model for BRONJ developed for human oral surgery and medicine. Veterinary patients treated with bisphosphonates may be at an increased risk for BRONJ There has been little, to no, investigation of potential long term side-effects of bisphosphonate use in veterinary patients; potential sequelae are unknown. The history of bisphosphonates, their use, and BRONJ in veterinary patients are discussed.
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Affiliation(s)
- Kevin Stepaniuk
- College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA.
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Abstract
Practical relevance Musculoskeletal neoplasia is an uncommon but Important differential diagnosis for cats presenting with lameness, pain or swellings associated with bones and/or soft tissues. The most common tumours of soft tissue origin are the sarcomas (in particular feline injection site sarcomas [FISSs]); the most common bone tumour of the cat is osteosarcoma (OSA). Clinical challenges FISSs present a clinical challenge in terms of their local invasiveness, difficulty in obtaining complete surgical excision and high risk of local recurrence. Axial and extraskeletal OSAs pose similar challenges, whereas appendicular OSA is usually easy to remove via limb amputation and can, therefore, carry a good prognosis in many cases. Patient group Cats of any age, gender or breed may be affected, although bone tumours predominantly affect middle- to old-aged cats. Global importance Vaccination of cats is of global importance in preventing feline diseases; hence, any possible significant consequences of vaccination such as neoplasia, even of a low incidence, are of huge concern to cat owners and veterinarians alike. Evidence base This review is based on current literature relating to pathogenesis, pathology, presentation, diagnosis, staging, treatment and prognosis. It aims to summarise feline musculoskeletal neoplasia for clinicians in general practice.
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Whitney JL, Barrs VR, Wilkinson MR, Briscoe KA, Beatty JA. Use of bisphosphonates to treat severe idiopathic hypercalcaemia in a young Ragdoll cat. J Feline Med Surg 2011; 13:129-34. [DOI: 10.1016/j.jfms.2010.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/23/2010] [Accepted: 09/08/2010] [Indexed: 02/07/2023]
Abstract
A 3-year-old Ragdoll cat was referred for investigation of polyuria, polydipsia, vomiting, weight loss and hypercalcaemia. Serum biochemical abnormalities included total and ionised hypercalcaemia and hypophosphataemia. Following clinical investigations a diagnosis of idiopathic hypercalcaemia was made. Because of the severity of the hypercalcaemia and the associated clinical signs, treatment for hypercalcaemia was commenced with pamidronate. Major electrolyte abnormalities were detected but, remarkably, were accompanied by minimal clinical signs. The cat was subsequently treated with oral alendronate and is clinically normal 15 months later. Reports of the use of bisphosphonates in cats are limited and close monitoring of patients is recommended.
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Affiliation(s)
- Joanna L. Whitney
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, NSW 2006, Australia
| | - Vanessa R.D. Barrs
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, NSW 2006, Australia
| | - Margaret R. Wilkinson
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - Katherine A. Briscoe
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, NSW 2006, Australia
| | - Julia A. Beatty
- Valentine Charlton Cat Centre, Faculty of Veterinary Science, The University of Sydney, NSW 2006, Australia
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