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Calcium and potassium disturbances in acute leukemia

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Summary

After seeing 3 leukemia patients with severe hypocalcemic tetany, a retrospective study was made of 506 serum potassium and serum calcium values in 51 deceased patients with acute leukemia.

One third of the patients had constant, and almost half had intermittent hypocalcemia. The hypocalcemia was significantly associated with hypoalbuminemia, and with preceding treatment with intestinal antibiotics (which may inhibit calcium absorption) or corticosteroids, which are believed to be contributory pathogenetic factors. Blood transfusion and infection did not seem to have an influence. Routine serum calcium estimates and possible calcium supplementation are proposed in patients with acute leukemia who have hypoalbuminemia, or are given intestinal antibiotics, corticosteroids or/and systemic antibiotics, especially tetracyclines. This, however, requires exact clinical supervision since it has been observed that acute leukemia may occasionally also be complicated by hypercalcemia.

No patient had constant, but over half of the patients had intermittent hypopotassemia. The possible consumption of serum potassium by the increased number of bone marrow cells in leukemia is discussed. Hypopotassemic samples were significantly associated with high fever and systematic antibiotics, with intestinal antibiotics, blood transfusions and possibly with corticosteroids. Routine serum potassium estimates and possible potassium supplementation is proposed in infected leukemia patients receiving antibiotics and steroids.

Zusammenfassung

Nachdem bei 3 leukämischen Patienten eine schwere hypokalzämische Tetanie beobachtet worden war, wurde eine retrospektive Studie bei 51 Patienten mit akuter Leukämie anhand von 506 Serumkalium-und Serumkalziumwerten durchgeführt.

Ein Drittel der Patienten, deren Serumkalziumwerte bestimmt wurden, hatte eine konstante und über die Hälfte der Patienten wies eine intermittierende Hypokalzämie auf. Die Hypokalzämie war von einer Hypoalbuminämie begleitet und es ging signifikant häufig eine Medikation von darmsterilisierenden Antibiotika (die möglicherweise die Kalzium-Absorption behindern) und Kortikosteroiden voraus, die als pathogene Faktoren angesehen werden können. Bluttransfusionen und Infekte scheinen keinen wesentlichen Einfluß auszuüben. Routinemäßige Serumkalziumbestimmungen und eventuelle prophylaktische Kalziumsubstitution scheinen bei jenen Patienten mit akuter Leukämie erforderlich, die eine Hypoalbuminämie aufweisen und unter Medikation von Antibiotika, Kortikosteroiden und unter Darmsterilisation stehen. Dies erfordert auf jeden Fall aber eine exakte klinische und laborchemische Kontrolle, da es bei akuten Leukämien zuweilen zum Auftreten hyperkalzämischer Episoden kommen kann.

Eine konstante Hypokalämie wies keiner von den untersuchten Patienten auf, aber über die Hälfte der Patienten hatte eine intermittierende Hypokalämie. Der mögliche Verbrauch von Serumkalium durch starke Zunahme der Zellzahl im Knochenmark wird diskutiert. Hypokalämische Werte traten signifikant häufig bei Fieber, Darmsterilisation, Bluttransfusionen und Medikation von Antibiotika auf. Ein möglicher Zusammenhang besteht auch mit der Gabe von Kortikosteroiden. Eine regelmäßige Kontrolle der Serumkaliumwerte wird bei jenen leukämischen Patienten vorgeschlagen, die Infekte aufweisen und/oder unter Behandlung mit Antibiotika, Kortikosteroiden stehen sowie einer Darmsterilisation unterzogen werden.

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Author notes

  1. Peter Reizenstein

    Present address: Dept. of Medicine (Section of Hematology), Karolinska Hospital Stockholm 60, Sweden

Authors and Affiliations

  1. Dept. of Medicine (Section of Hematology), Karolinska Hospital Stockholm 60, Sweden

    Paul Höcker

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  1. Paul Höcker
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Council of Europe Research Fellow on leave from the 1st Med. Dept. (Head: Prof. Dr. H. Fleischhacker) and from the Ludwig Bolzmann Institute for Leukemia Research and Hematology (Head: Doz Dr. A. Stacher, Hanuschkrankenhaus, Viena.

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Höcker, P., Reizenstein, P. Calcium and potassium disturbances in acute leukemia. Blut 29, 398–406 (1974). https://doi.org/10.1007/BF01633675

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