慢性肾脏病患者使用地舒单抗致严重低钙血症1例

Severe hypocalcemia after denosumab administration in a patient with chronic kidney disease:a case report

1例43岁女性慢性肾脏病5期患者,因骨质疏松症给予地舒单抗60 mg皮下注射1次,用药前血钙2.25 mmol·L^(-1),用药13 d后出现四肢、口角麻木及肌肉痉挛,血钙降至1.12 mmol·L^(-1),心电图示Q-T间期延长。经静脉联合口服钙剂和活性维生素D治疗后症状缓解,血钙升至2.23 mmol·L^(-1)。出院后继续口服药物补钙,随诊半年发现患者仍反复出现低钙血症。采用Naranjo's评估量表进行关联性评价,考虑严重且顽固的低钙血症与使用地舒单抗“很可能有关”。提示应警惕慢性肾脏病患者使用地舒单抗后发生低钙血症的风险,加强用药前评估和用药后监测,保障患者用药安全。

A 43-year-old female patient with chronic kidney disease stage 5 received a single subcutaneous dose of 60 mg of denosumab for osteoporosis.Prior to treatment,her calcium level was 2.25 mmol·L^(-1).After 13 days,she experienced numbness in her limbs and mouth corners,as well as muscle spasms.Her blood calcium dropped to 1.12 mmol·L^(-1),and an electrocardiogram revealed a prolonged QT interval.Symptoms improved with intravenous and oral calcium plus active vitamin D treatment,raising her blood calcium to 2.23 mmol·L^(-1).Following discharge from the hospital,the patient continued oral calcium supplementation.However,during the six-month follow-up period,it was observed that the patient still experienced recurrent hypocalcemia.The Naranjo’s assessment scale indicated that severe and refractory hypocalcemia was very likely associated with denosumab.This case highlights the importance of vigilance for hypocalcemia in chronic kidney disease patients following denosumab administration,emphasizing the need for thorough pre-medication assessment and post-medication monitoring to ensure patient safety.