Hypercalcemic crisis in acute leukemia

Abstract The clinical course and management of two patients with acute leukemia and hypercalcemia are described. One patient had pre-existing reticulum cell sarcoma, the other chronic lymphocytic leukemia. In both patients bone marrow proliferation and hypercalcemia coincided, suggesting increased bone resorption rather than excess parathyroid hormone production as a cause for the electrolyte imbalance. Futhermore, radioimmunoassay for this hormone performed on serum and tissue specimens from one subject were negative. The hypercalcemia in both patients responded to intravenous sodium sulfate therapy. Metabolic balance studies were performed in one of the subjects, in whom hypokalemia was noted during and after the administration of sodium sulfate, and potassium supplements had to be given. These two cases illustrate that hypercalcemic crisis may complicate acute leukemia. Successful management of this complication requires both treatment of acute hypercalcemia and control of the leukemia to limit further bone destruction.