# Pamidronate-induced irreversible symptomatic hypocalcemia in a dog with hypercalcemia after glucocorticoid withdrawal: a case report

## TL;DR

A dog developed severe, irreversible low calcium levels after receiving pamidronate to treat high calcium caused by stopping long-term steroid use.

## Contribution

Reports a rare case of irreversible hypocalcemia following pamidronate use in a dog with hypercalcemia due to glucocorticoid withdrawal.

## Key findings

- A single pamidronate injection led to severe and irreversible hypocalcemia in a dog.
- The dog's pre-existing conditions worsened after treatment, leading to euthanasia.
- Bisphosphonates like pamidronate can cause life-threatening hypocalcemia in certain patients.

## Abstract

Pamidronate is used for the treatment of hypercalcemia. However, a rare but potential adverse event of pamidronate treatment is hypocalcemia. This report describes an unusual case of severe, irreversible hypocalcemia after a single injection of pamidronate for the treatment of hypercalcemia due to glucocorticoid withdrawal in a dog.

An 11-year-old castrated male Maltese dog presented with anorexia, vomiting, and diarrhea (day 0). The patient had calcinosis cutis throughout the body, calcification of intraabdominal organs, mild azotemia, and severe hypercalcemia. The severe calcification was attributed to long-term glucocorticoid administration, which was discontinued 1 month before presentation. Fluid therapy, diuretics, calcitonin, and a single intravenous injection of pamidronate were used for the treatment of hypercalcemia. On day 14, normocalcemia was achieved, but renal failure occurred. On day 20, severe and irreversible hypocalcemia occurred, and on day 42, the patient was euthanized at the owner’s request because of worsened hypocalcemia and renal failure.

Although hypocalcemia is an extremely rare adverse event of bisphosphonate treatment, bisphosphonates like pamidronate can result in potentially life-threatening conditions according to the patient’s underlying conditions. Therefore, the patient’s condition should be closely monitored and any underlying conditions should be carefully evaluated before initiating the treatment for hypercalcemia using pamidronate.

The online version contains supplementary material available at 10.1186/s12917-024-04030-x.