Electrolyte Disturbances and Cardiac Arrhythmias in a Dog Following Pamidronate, Calcitonin, and Furosemide Administration for Hypercalcemia of Malignancy

Pamidronate-induced irreversible symptomatic hypocalcemia in a dog with hypercalcemia after glucocorticoid withdrawal: a case report

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.

Case report: Focal segmental glomerulosclerosis and nephrotic syndrome following treatment with pamidronate for calcitriol toxicity

Objective

This study aimed to describe a case of glomerulosclerosis resulting in nephrotic syndrome following the administration of pamidronate disodium to treat clinical calcitriol toxicity in a dog.

Case summary

A 12-week-old intact male Labrador Retriever weighing 11.8 kg presented with lethargy and vomiting for 20 h after ingesting a 100 g tube of topical antipsoriatic cream (3 mcg/g of calcitriol; Vectical Ointment™, Galderma, Lausanne, Switzerland). Severe hypercalcemia was present on the day of the presentation. Hypercalcemia treatments such as saline diuresis, furosemide (Salix®, furosemide, Merck Animal Health, Kenilworth, NJ), and dexamethasone sodium phosphate (Dexamethasone SP, Mylan, Canonsburg, PA) were initiated. The dog was also administered a single dose of pamidronate disodium (Pamidronate disodium, Mylan, Canonsburg, PA) on the day of presentation. Initially, the patient's clinical signs improved, and the hypercalcemia resolved. Exactly 130 h post-pamidronate disodium (Dexamethasone SP, Mylan, Canonsburg, PA) administration, the patient developed biochemical abnormalities and severe edema, consistent with nephrotic syndrome, and was euthanized. Necropsy results revealed evidence of focal segmental glomerulosclerosis (FSGS).

Unique information

Pamidronate disodium, commonly used for the treatment of hypercalcemia, may have resulted in glomerulosclerosis and nephrotic syndrome in a dog with calcitriol toxicity. This complication should be taken into consideration when monitoring patients treated with pamidronate disodium for hypercalcemia.

Canine Apocrine Gland Anal Sac Adenocarcinoma: A Review

Apocrine gland anal sac adenocarcinoma (AGASAC) is a relatively uncommon tumor in the dog and comprises approximately 17% of perianal malignancies; however, it is one of the most common causes of paraneoplastic hypercalcemia. Clinical signs in affected dogs most commonly are associated with mechanical obstruction caused by the primary tumor or enlarged regional metastatic lymph nodes and the effects of paraneoplastic hypercalcemia when present. Surgical excision of the primary tumor and metastasectomy of affected locoregional lymph nodes is the preferred initial treatment option for most dogs, although radiation therapy and adjuvant chemotherapy are commonly incorporated into multi-modality treatment plans. A significant role for the use of adjuvant chemotherapy has not been clearly demonstrated. Prolonged survival times are possible, especially for dogs with smaller primary tumors and for dogs that undergo further treatments for recurrent disease. In this article, we review the clinical signs, diagnosis, staging, treatment, and prognosis of AGASAC in the dog.

Parathyroid immunohistochemistry in a 12-year-old mixed-breed dog with parathyroid adenocarcinoma

Summary

A 12-year-old, female, spayed, mixed-breed dog with acute lethargy, anorexia and weakness and markedly elevated total and ionised calcium concentration showed an enlarged left cranial parathyroid gland on ultrasonography of the ventral neck. Despite preoperative therapy with furosemide and calcitonin, there was no decline of plasma ionised calcium concentration. The dog deteriorated rapidly and was euthanased two days after initial presentation. Postmortem histopathology revealed parathyroid tissue with characteristics of malignancy as local and vascular invasion. Immunohistochemistry showed parathyroid hormone positive staining of these cells. Unusual clinical presentation and histopathological characteristics are discussed.

Extravasation reactions associated with the administration of pamidronate: 11 cases (2008-2013)

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.

Acute management of calcium disorders

Acute management of hypercalcemia and hypocalcemia is an important part of small-animal emergency practice. In addition to hypercalcemia of malignancy and hyperparathyroidism, vitamin D toxicosis is becoming more common in companion animals as new and improved rodenticides and human pharmaceutical preparations (vitamin D analog skin creams) become more available. This article provides complete details regarding the emergency management of life-threatening hypercalcemia with focus on vitamin D intoxication. At the other end of the spectrum, hypocalcemic emergencies, such as periparturient hypocalcemia (eclampsia), may be less common but are often life threatening. This article contains guidelines for the emergency management of hypocalcemia. In summary, the urgent care of calcium disorders in small animals is reviewed.

Bisphosphonate related osteonecrosis of the jaws: a review

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.

The role of bisphosphonates in the management of patients that have cancer

Bisphosphonates are pharmacologic agents widely used in people for managing pathologic bone resorptive conditions. Based on their physicochemical properties, bisphosphonates concentrate within areas of active bone remodeling and induce osteoclast apoptosis. Appropriate use of bisphosphonates for treating companion animals requires a thorough understanding of how bisphosphonates exert their biologic effects. This review article highlights general properties of bisphosphonates, including their pharmacology, mechanisms of action, adverse side effects, anticancer mechanisms, surrogate markers for assessing response, and potential clinical utility for treating dogs and cats diagnosed with malignant skeletal tumors.