[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
January 2009

Severe Symptomatic Hypocalcemia in a Patient With RDEB Treated With Intravenous Zoledronic Acid

Arch Dermatol. 2009;145(1):95-96. doi:10.1001/archdermatol.2008.536

A 15-year-old boy with recessive dystrophic epidermolysis bullosa (RDEB) had severe osteopenia (lumbar spine bone mineral density, 0.348 g/cm2) (z score, −4.6; bone age–corrected z score, −3.6 [normal z score, greater than −2]) and compression fractures causing him to be bedridden. Prior to infusion of bisphosphonate, levels of serum ionized calcium (4.36 mg/dL; normal, 3.40-5.80 mg/dL), parathyroid hormone, phosphorous, and 25-hydroxyvitamin D were normal, as were results from renal function tests. He received intravenous elemental calcium (25 mg/kg) for hypocalcemia prophylaxis prior to his single intravenous bisphosphonate zoledronic acid infusion, 0.1 mg/kg (total dose, 4 mg, the recommended adult dose). This treatment was followed by administration of a repeated dose of intravenous elemental calcium (25 mg/kg), and then oral elemental calcium was prescribed (1500 mg, twice daily) along with cholecalciferol (6000 IU/d). Initial ionized calcium levels were normal for the next 24 hours. (To convert serum ionized calcium to millimoles per liter, multiply by 0.25.)

First Page Preview View Large
First page PDF preview
First page PDF preview