Calcium kinetic in a patient with acute renal failure due to rhabdomyolysis: a case report and review of literature.

Hypercalcemia may follow hypocalcemia in the course of acute renal failure (also named now as acute kidney injury) secondary to rhabdomyolysis. The clinician should be aware of calcium kinetics to avoid the complications of both hypocalcemia and hypercalcemia which may occur at few days interval during the recovery phase. This report presents a case of a young male who developed anuric Acute Renal Failure due to strenuous exercise induced rhabdomyolysis. He was treated with supportive, corrective and dialysis measures. The progress was favorable with a diuretic phase. During the diuretic phase, he developed progressive hypercalcemia reaching up to 3.54 mEq/l with constipation and drowsiness. Investigations showed besides stigmata of rhabdomyolysis and Acute Renal Failure, low initial levels of vitamin D metabolites. The calcemia eventually normalized with fluids, dialysis and a single dose of Pamidronate Sodium. The patient was discharged 3 weeks after admission with a recovered clinical condition, improved renal functions and normal calcemia. The biphasic kinetics of calcium in this setting is documented. We conclude that serum corrected calcium should be monitored in the context of Acute Renal Failure due to rhabdomyolysis.