Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Aug 12:5:367.
doi: 10.1186/1752-1947-5-367.

Life-threatening hyperkalemia following zoledronic acid infusion for Paget's disease: a case report

Eleftheria Panteliou  1 , Neil Young, Morag Naysmith
Affiliations

Life-threatening hyperkalemia following zoledronic acid infusion for Paget's disease: a case report

Eleftheria Panteliou et al. J Med Case Rep. .

Abstract

Introduction: Zoledronic acid is a highly effective treatment in Paget's disease for persistent bone pain and prevention of further progression of the disease. The commonest electrolyte abnormality is hypocalcemia. To the best of our knowledge this is the first case of hyperkalemia secondary to zoledronic acid to be published in the world literature. The commonest arrhythmia related to zoledronic acid is atrial fibrillation.

Case presentation: We describe the case of an 80-year-old Caucasian man, with a history of ischemic heart disease, who had an in-hospital cardiac arrest related to hyperkalemia. Increasing potassium levels were noted following his first zoledronic acid infusion for symptomatic control of bone pain secondary to Paget's disease. Our patient suffered a cardiac arrest 10 days following the zoledronic acid infusion. Our patient's biochemistry and electrocardiogram output were monitored until his death 26 days after his cardiac arrest. Our patient developed paroxysmal atrial fibrillation in the post-resuscitation period and there was persistent hyperkalemia that required prolonged treatment with calcium resonium. All other possible causes of hyperkalemia were excluded.

Conclusion: In our patient's case persistent hyperkalemia and life-threatening arrhythmias were associated with use of zoledronic acid. These side effects have not been reported before and the causative mechanism is far from clear as there are no obvious systemic effects of zoledronic acid. The combination of zoledronic acid with predisposing factors such as structural heart disease might account for the clinical picture we witnessed. As a result, electrolyte monitoring should be adopted early in zoledronic acid use. Further studies are required to elucidate the underlying mechanism of hyperkalemia and identify the target group of patients where zoledronic acid can be safely administered. Great caution is advised in patients with underlying heart conditions.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Potassium levels prior and after zoledronic acid infusion (day 0).
See this image and copyright information in PMC

References

    1. UK Medicines and Healthcare Products Regulatory Agency. Intravenous zoledronic acid: adverse effects on renal function. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON087704
    1. Van Beek E, Cohen L, Leroy I, Ebetino F, Löwik C, Papadopoulos S. Differentiating the mechanisms of antiresorptive action of nitrogen containing bisphosphonates. Bone. 2003;33:805–811. doi: 10.1016/j.bone.2003.07.007. - DOI - PubMed
    1. Chen T, Berenson J, Vescio R, Swift R, Gilchick A, Goodin S, LoRusso S, Ma P, Ravera C, Deckert F, Schran H, Seaman J, Skerjanec A. Pharmakokinetics and pharmacodynamics of zoledronic acid in cancer patients with bone metastases. J Clin Pharmacol. 2002;42:1228–1236. doi: 10.1177/009127002762491316. - DOI - PubMed
    1. Omoigui S. Cholesterol synthesis is the trigger and isoprenoid dependent interleukin-6 mediated inflammation is the common causative factor and therapeutic target for atherosclerotic vascular disease and age-related disorders including osteoporosis and type 2 diabetes. Med Hypotheses. 2005;65:559–569. doi: 10.1016/j.mehy.2005.03.012. - DOI - PubMed
    1. Dicuonzo G, Vincenzi B, Santini D, Avvisati G, Rocci L, Battistoni F, Gavasci M, Borzomati D, Coppola R, Tonini G. Fever after zoledronic acid administration is due to increase in TNF- and IL-6. J Interferon Cytokine Res. 2003;23:649–654. doi: 10.1089/107999003322558782. - DOI - PubMed