Background Severe hypocalcaemia and hypophosphataemia following the co‐administration of denosumab and IV ferric carboxymaltose has previously been reported in the setting of chronic kidney disease and malignancy. Despite scarce evidence, there has been growing concern amongst clinicians of a possible drug interaction between denosumab and IV iron therapies. Although electrolyte abnormalities are well known side effects of these individual therapies, it is possible that co‐administration of the agents can exaggerate these effects and result in a potentially life‐threatening interaction. Aim We present a case of profound hypocalcaemia and hypophosphataemia following same day administration of denosumab and IV ferric carboxymaltose in a hospitalised older patient. Clinical details An older female with normal renal function, serum calcium, phosphate and 25‐hydroxy‐vitamin D levels, and no history of malignancy was given denosumab 60 mg SC for secondary fracture prophylaxis following an acute osteoporotic fracture. On the same day, she received ferric carboxymaltose 1 g IV for treatment of iron‐deficiency anaemia. Outcomes Following a review of her pathology results during the inpatient hospital admission, profound hypocalcaemia and hypophosphataemia was identified 8 days after denosumab and ferric carboxymaltose administration. Despite supplementation, electrolyte abnormalities persisted for 12 days following administration. Conclusion Although the patient had no pre‐existing risk factors for developing electrolyte disturbance, profound hypocalcaemia and hypophosphatemia following denosumab and IV ferric carboxymaltose administration occurred, suggesting a possible interaction between the two therapies. Caution should be exercised by clinicians when these agents are co‐administered within a close timeframe.
Neurolymphomatosis (NL) is the infiltration of lymphocytes into the peripheral nervous system in a haematological malignancy. We describe the imaging features of NL in a patient with relapsed Burkitt-like non-Hodgkin’s lymphoma on positron emission tomography (PET) and ultrasound. Imaging features on ultrasound are infrequently described and provide useful information in helping to establish an imaging diagnosis of NL. Features of NL in our patient included intense linear fluorodeoxyglucose-18 (18FDG) uptake on PET along the affected median nerve. B-mode ultrasound demonstrated concentric tubular thickening and loss of fascicular architecture. Perineural and intraneural vascularity was present on colour Doppler ultrasound. It is important to be able to correlate ultrasound findings to features observed on 18FDG-PET as this aids in diagnosis and in guiding potential surgical biopsy.
Background Residential respite is an important support for many community‐dwelling older Australians and their caregivers. Respite clients are often very frail with high or specific care needs. Little is known about the comparative outcomes of hospital admission between permanent residential aged care facility (RACF) residents and residential respite residents. Aim To determine the number of residential respite clients admitted to an acute tertiary hospital, and compare characteristics and in‐hospital outcomes with those of permanent residential care residents. Methods Retrospective study of residential respite patients admitted to an Australian tertiary hospital between November 2014 and September 2017. Comparison groups: all RACF patients admitted during same period (general RACF group), and control group matched (2:1) for aged, gender and diagnosis. Main outcome measures: in‐hospital mortality, hospital length of stay (LOS), in‐hospital complications (including fall, delirium, pressure injury, Medical Emergency Team (MET) call). Comparisons adjusted for age, gender, presenting symptom and matching variable. Results A total of 166 admissions from residential respite and 332 matched RACF controls identified from 4575 admissions for permanent RACF residents. Mortality was significantly higher in respite group versus general RACF group (15.1 vs 8.2%, P < 0.001) but not matched control group (15.1 vs 16.3%, P = 0.795). LOS was significantly higher in respite patients than either control group. Respite patients had significantly higher prevalence of in‐hospital fall (10.8 vs 1.5%, P < 0.0001) and delirium (35.5 vs 17.7%, P < 0.001) than matched RACF controls. No significant differences were seen in in MET‐call and pressure injury rates. Conclusion Although residential respite recipients represent a minority of total residential aged care admissions, they are at high risk of poor outcomes. Prospective identification and timely intervention may improve quality of care for this vulnerable cohort.
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