Reactions 1464, p6 - 10 Aug 2013

O SAlginic acid/calcium carbonate/magnesium carbonate

Severe hypercalcaemia and renal failure: casereport

A 59-year-old woman developed severe hypercalcaemia andrenal failure after the excessive use of alginic acid/calciumcarbonate/magnesium carbonate [Rennies Dual Action].

The woman presented to an emergency room withvomiting, diarrhoea and dysarthria. She was noted to haveorofacial dyskinesia. Blood tests showed a corrected calciumlevel of 5.2 mmol/L and renal impairment (creatinine 308µmol/L). Her serum level of 1,25-dihydroxyvitamin D wasmarkedly elevated, at > 250 nmol/L.

The woman was administered aggressive IV fluidresuscitation. When questioned, she admitted to the excessiveuse of alginic acid 150mg/calcium carbonate 625mg/magnesium carbonate 73.5mg tablets for many years, typicallyconsuming 4–6 tablets per day. Due to worsening heartburnand gastrointestinal symptoms, she had recently beenconsuming up to 18 tablets per day. Her diarrhoea persisted,and her liver function tests became deranged. Subsequentbiopsies were suggestive of Crohn’s disease, for which shewas commenced on treatment. She was rehydrated withnormal saline, and her serum calcium level normalised after5 days. Her serum creatinine also subsequently stabilised.Alginic acid/calcium carbonate/magnesium carbonate wasstopped. She remained normocalcaemic at 8 months’ follow-up.

Author comment: "[The patient’s] very severehypercalcaemia [was] initiated by a prolonged excess intake ofcalcium carbonate and alkali. . . Progressive hypercalcaemialed to renal impairment, which, by decreased calciumexcretion, further contributed to hypercalcaemia".Zemrak F, et al. Rennies, Crohn's disease and severe hypercalcaemia. BMJCase Reports 2010: 20 Dec 2010. Available from: URL: http://dx.doi.org/10.1136/bcr.07.2010.3138 - United Kingdom 803091134

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Reactions 10 Aug 2013 No. 14640114-9954/13/1464-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved