Abstract
A 10-year-old 40-kg African-American female with megacystis microcolon hypoperistalsis syndrome maintained on total parenteral nutrition (TPN), with a history of metabolic bone disease and renal insufficiency, was admitted with a Candida parapsilosis central venous line infection. During her 280-day hospital stay, she had multiple episodes of bacteremia and recurrent candidemia. Furthermore, she developed pathological fractures and hip displacement with osteomyelitis due to Enterobacter. Hypercalcemia and a history of nephrocalcinosis had prevented appropriate dosing of calcium prior to and during the first months of her hospital stay. Pamidronate and chlorothiazide were added to her regimen. The urinary calcium to creatinine ratio and ionized calcium decreased. The pamidronate dose was increased to 60 mg once a week and was well tolerated. Daily calcium was added to her TPN solution and was increased to 10 mEq/day by the time of discharge. We conclude that relatively large doses of pamidronate may be required in certain cases of refractory hypercalcemia and are well tolerated in children.
References
Srikanth MS, Ford EG, Isaacs H Jr, Mahour GH (1993) Megacystis microcolon intestinal hypoperistalsis syndrome: late sequelae and possible pathogenesis. J Pediatr Surg 28:957–959
Koo WWK (1992) Parenteral nutrition-related bone disease. J Parenter Enter Nutr 16:386–394
Committee on Nutrition (1996) Aluminum toxicity in infants and children. Pediatrics 97:413–416
Fleisch H (1991) Biphosphonates: pharmacology and use in the treatment of tumour-induced hypercalcaemic and metastatic bone disease. Drugs 42:919–944
Kantrowitz FG, Byrne MH, Schiller AL, Krane SM (1975) Clinical and biochemical effects of diphosphonate in Paget's disease of bone (abstract). Arthritis Rheum 18:407
Bounameaux HM, Schifferli J, Montani JP, Jung A, Chatelan F (1983) Renal failure associated with intravenous diphosphonate. Lancet 1:471
Tyrrell CJ, Collinson M, Madsen EL, Ford JM, Coleman T (1994) Intravenous pamidronate: infusion rate and safety. Ann Oncol 5 [Suppl 7]:S27–S29
Astrom E, Soderhall S (1998) Beneficial effect of bisphosphonate during five years of treatment of severe osteogenesis imperfecta. Acta Paediatr 87:64–68
Bembi B, Agosti E, Boehm P, Nassimbeni G, Zanatta M, Vidoni L (1994) Aminohydroxypropylidene-biphosphonate in the treatment of bone lesions in a case of Gaucher's disease type 3. Acta Paediatr 83:122–124
Bembi B, Parma A, Bottega M, Ceschel S, Zanatta M, Martini C, Ciana G (1997) Intravenous pamidronate treatment in osteogenesis imperfecta. J Pediatr 131:662–665
Fujiwara I, Ogawa E, Igarashi Y, Ohba M, Asanuma A (1998) Intravenous pamidronate treatment in osteogenesis imperfecta. Eur J Pediatr 157:261–262
Glorieux FH, Bishop NJ, Plotkin H, Chabot G, Lanoue G, Travers R (1998) Cyclic administration of pamidronate in children with severe osteogenesis imperfecta. N Engl J Med 339:947–952
Gonzalez E, Pavia C, Ros J, Villaronga M, Valls C, Escola J (2001) Efficacy of low dose schedule pamidronate infusion in children with osteogenesis imperfecta. J Pediat Endocrinol Metab 15:529–533
Lala R, Matarazzo P, Bertelloni S, Buzi F, Rigon F, De Sanctis C (2000) Pamidronate treatment of bone fibrous dysplasia in nine children with McCune-Albright syndrome. Acta Paediatr 89:188–193
Sellers E, Sharma A, Rodd C (1998) The use of pamidronate in three children with renal disease. Pediatr Nephrol 12:778–781
Shaw NJ, Boivin CM, Crabtree NJ (2000) Intravenous pamidronate in juvenile osteoporosis. Arch Dis Child 83:143–145
Zacharin M, Cundy T (2000) Osteoporosis pseudoglioma syndrome: treatment of spinal osteoporosis with intravenous bisphosphonates J Pediatr 137:410–415
Zacharin M, O'Sullivan M (2000) Intravenous pamidronate treatment of polyostotic fibrous dysplasia associated with the McCune Albright syndrome. J Pediatr 137:403–409
Brumsen C, Hamdy NAT, Papapoulos SE (1997) Long-term effects of bisphosphonates on the growing skeleton. Studies of young patients with severe osteoporosis. Medicine (Baltimore) 76:266–283
Ralston SH, Gardner MD, Dryburgh FJ, Jenkins AS, Cowan RA, Boyle IT (1985) Comparison of aminohydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcaemia. Lancet II:907–910
Chakravarty K, Merry P, Scott DGI (1994) A single infusion of bisphosphonate AHPrBP in the treatment of Paget's disease of bone. J Rheumatol 21:2118–2121
Boudailliez BR, Pautard BJ, Sebert JL, Kremp O, Piussan CX (1990) Leukaemia-associated hypercalcemia in a 10-year-old boy: effectiveness of aminohydroxypropylidene biphosphonate. Pediatr Nephrol 4:510–511
De Schepper J, Pont S de, Smitz J, De Coster D, Schots R, Otten J (1999) Metabolic disturbances after a single dose of 30 mg pamidronate for leukaemia-associated hypercalcemia in a 11-year-old boy. Eur J Pediatr 158:765–768
Kutluk MT, Hazar V, Akyuz C, Varan A, Buyukpamukcu M (1997) Childhood cancer and hypercalcemia: report of a case treated with pamidronate. J Pediatr 130:828–831
Lteif AN, Zimmerman D (1998) Bisphosphonates for treatment of childhood hypercalcemia. Pediatrics 102:990–993
Profumo RJ, Reese JC, Foy TM, Garibaldi LR, Kane RE (1994) Severe immobilization-induced hypercalcemia in a child after liver transplantation successfully treated with pamidronate. Transplantation 57:301–303
Hoekman K, Papapoulos SE, Peters ACB, Bijvoet OLM (1985) Characteristics and bisphosphonate treatment of a patient with juvenile osteoporosis. J Clin Endocrinol Metab 61:952–956
Attard TM, Dhawan A, Kaufman SS, Collier DS, Langnas AN (1998) Use of disodium pamidronate in children with hypercalcemia awaiting liver transplantation. Pediatr Transplant 2:157–159
Kodama H, Kubota K, Abe T (1998) Osteogenesis imperfecta: are fractures and growth hormone treatment linked (letter)? J Pediatr 132:559–560
Roldan EJA, Pasqualini T, Plantalech L (1999) Bisphosphonates in children with osteogenesis imperfecta may improve bone mineralization but not bone strength. Report of two patients. J Pediatr Endocrinol Metab 12:555–559
Zumkeller W, Jassoy A, Lebek S, Nagel M (2001) Clinical, endocrinological and radiological features in a child with McCune-Albright syndrome and pituitary adenoma. J Pediatr Endocrinol Metab 14:553–559
Shaw NJ, White CP, Fraser WB, Rosenbloom L (1994) Osteopenia in cerebral palsy. Arch Dis Child 71:235–238
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Duke, J.L., Jones, D.P., Frizzell, N.K. et al. Pamidronate in a girl with chronic renal insufficiency dependent on parenteral nutrition. Pediatr Nephrol 18, 714–717 (2003). https://doi.org/10.1007/s00467-003-1162-9
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DOI: https://doi.org/10.1007/s00467-003-1162-9