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Hypocalcemia and Hypercalcemia in Patients with Rhabdomyolysis with and without Acute Renal Failure^*

Division of Nephrobgy, Department of Medicine, and the Department of Nuclear Medicine, University of Southern California School of Medicine; and the Department ofBiochemistry, University of California Riverside Los Angeles, California 90033

Address all correspondence and requests for reprints to: Shaul G. Massry, M.D., Division of Nephrology, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles, California 90033.

Patients with rhabdomyolysis (RBD) and acute renal failure (ARF) are hypocalcemic during the oliguric phase of ARF and over 30% develop hypercalcemia during the diuretic phase. The present study examined the factors underlying these derangements in calcium metabolism in 15 patients: 7 with RBD and ARF, 4 with RBD only, and 4 with ARF only. All patients had hypocalcemiaon admission and the hypocalcemia was more pronounced in those with RBD and ARF. All patients with RBD independent of the presence or absence of ARF had calcium deposition in soft tissues as documented by technetium-99 scan. In 4 patients with RBD and ARF, hypercalcemia developed duringthe diuretic phase at a time when Serum PTH levels were undetectable. Only patients with RBD and ARF had a significant increase in serum levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D [1,25(OH)₂P] during the diuretic phase and both the increments in and the levels of 1,25(OH)₂D were significantly greater in those who were hypercalcemic. The data indicate that 1) hypocalcemia occurs in RBD independent of ARF and is most likely related to calcium deposition in injured tissues, and 2) elevation in serum levels of 1,25(OH)₂D plays an important role in the genesis of hypercalcemia during the diuretic phase of patients with RBD and ARF. Our observations suggestthat extrarenal production of 1,25(OH)₂D may occur in these patients, and/or that the renal production of 1,25(OH)₂D may not be so tightly controlled as it is in normal subjects.

^* This work was supported by a Grant AM-29955 from the NIADDK.

Received November 5, 1985.

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