A rare case report of multiple myeloma presenting with paralytic ileus and type II respiratory failure due to hypercalcemic crisis

Guo, Yuchen; He, Liang; Liu, Yiming; Cao, Xueyuan

doi:10.1097/md.0000000000009215

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…25 Alterations of serum calcium have been linked to the development of ARF in several case reports. [26][27][28][29][30] While hypocalcaemia can lead to ARF due to muscle weakness, tetany, laryngeal and bronchospasm, patients with severe hypercalcaemia can present with lethargy, confusion and coma, resulting in ARF. [26][27][28][29][30] However, previously described cases focused on the total serum calcium concentration, and the risk of in-hospital ARF among patients with various serum ionised calcium levels is not elucidated in a large clinical study.…”

Section: Introductionmentioning

confidence: 99%

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

et al. 2020

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ObjectivesThe objective of this study was to evaluate the risk of acute respiratory failure in all hospitalised patients based on admission serum ionised calcium.DesignA retrospective cohort study.SettingA tertiary referral hospital in Rochester, Minnesota, USA.ParticipantsAll hospitalised patients who had serum ionised calcium measurement within 24 hours of hospital admission from January 2009 to December 2013. Patients who were mechanically ventilated at admission were excluded.PredictorsAdmission serum ionised calcium levels was stratified into six groups: ≤4.39, 4.40–4.59, 4.60–4.79, 4.80–4.99, 5.00–5.19 and ≥5.20 mg/dL.Primary outcome measureThe primary outcome was the development of acute respiratory failure requiring mechanical ventilation during hospitalisation. Logistic regression analysis was fit to assess the independent risk of acute respiratory failure based on various admission serum ionised calcium, using serum ionised calcium of 5.00–5.19 mg/dL as the reference group.ResultsOf 25 709 eligible patients, with the mean serum ionised calcium of 4.8±0.4 mg/dL, acute respiratory failure requiring mechanical ventilation occurred in 2563 patients (10%). The incidence of acute respiratory failure was lowest when admission serum ionised calcium was 5.00–5.19 mg/dL, with the progressively increased risk of acute respiratory failure with decreased serum ionised calcium. In multivariate analysis with adjustment for potential confounders, the increased risk of acute respiratory failure requiring mechanical ventilation was significantly associated with admission serum ionised calcium of ≤4.39 (OR 2.52; 95% CI 2.12 to 3.00), 4.40–4.59 (OR 1.76; 95% CI 1.49 to 2.07) and 4.60–4.79 mg/dL (OR 1.48; 95% CI 1.27 to 1.72), compared with serum ionised calcium of 5.00–5.19 mg/dL. The risk of acute respiratory failure was not significantly increased when serum ionised calcium was at least 4.80 mg/dL.ConclusionThe increased risk of acute respiratory failure requiring mechanical ventilation was observed when admission serum ionised calcium was lower than 4.80 mg/dL in hospitalised patients.

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Section: Introductionmentioning

confidence: 99%

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

et al. 2020

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“…[15,36] Hypocalcemia can lead to ARF due to muscle weakness, hand and foot twitching, and laryngeal and bronchospasms, and patients with severe hypercalcemia can present with lethargy, confusion, and coma, leading to ARF. [37][38][39][40][41] Altogether, lower serum calcium levels are associated with a higher risk of ARF The results of this study show that the higher the RDW/ CA, the lengthier the hospital stay. A higher RDW/CA indicates either a higher RDW or a lower calcium level.…”

Section: Discussionmentioning

confidence: 62%

“…[15,36] Hypocalcemia can lead to ARF due to muscle weakness, hand and foot twitching, and laryngeal and bronchospasms, and patients with severe hypercalcemia can present with lethargy, confusion, and coma, leading to ARF. [37–41] Altogether, lower serum calcium levels are associated with a higher risk of ARF development. However, few studies have investigated the effects of RDW/CA on mortality in patients with ARF.…”

Section: Discussionmentioning

confidence: 99%

The relationship between red cell distribution width, serum calcium ratio, and in-hospital mortality among patients with acute respiratory failure: A retrospective cohort study of the MIMIC-IV database

Dai,

Guo,

Zhou

et al. 2024

Medicine

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To investigate the impact of RDW/CA (the ratio of red cell distribution width to calcium) on in-hospital mortality in patients with acute respiratory failure (ARF). This retrospective cohort study analyzed the data of 6981 ARF patients from the Medical Information Mart for Intensive Care (MIMIC-IV) database 2.0. Critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Center in Boston. The primary outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether the RDW/CA ratio independently correlated with in-hospital mortality. The Kaplan–Meier method was used to plot the survival curves of the RDW/CA. Subgroup analyses were performed to measure the mortality across various subgroups. After adjusting for potential covariates, we found that a higher RDW/CA was associated with an increased risk of in-hospital mortality (HR = 1.17, 95% CI: 1.01–1.35, P = .0365) in ARF patients. A nonlinear relationship was observed between RDW/CA and in-hospital mortality, with an inflection point of 1.97. When RDW/CA ≥ 1.97 was positively correlated with in-hospital mortality in patients with ARF (HR = 1.554, 95% CI: 1.183–2.042, P = .0015). The Kaplan–Meier curve indicated the higher survival rates for RDW/CA < 1.97 and the lower for RDW/CA ≥ 1.97 after adjustment for age, gender, body mass index, and ethnicity. RDW/CA is an independent predictor of in-hospital mortality in patients with ARF. Furthermore, a nonlinear relationship was observed between RDW/CA and in-hospital mortality in patients with ARF.

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“…Small bowel obstruction may also be involved in patients presenting with EMP, causing tethering of the bowel loops owing to plasma cell infiltration into the peritoneum [7,8]. Meanwhile, previous studies revealed that hypercalcemic crisis resulted in paralytic ileus, which may be a deteriorating factor contributing to decreased bowel motion [9,10]. Overall, a duodenal ulcer combined with GI hemorrhage and small bowel obstruction is rare, and has not been reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Duodenal Ulcer with Massive Gastrointestinal Hemorrhage as an Initial Manifestation in Multiple Myeloma with Extramedullary Disease: A Case Report

et al. 2022

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Plasma cell neoplasms are characterized by dysregulated proliferation of mature B cells, which can present with either single (solitary plasmacytoma) or systemic (multiple myeloma (MM)) involvement. MM with extramedullary plasmacytoma (EMP) is a rare disease that accounts for approximately 3–5% of all plasmacytomas. EMP with gastrointestinal (GI) system involvement is an even rarer entity, accounting for <1% of MM cases. We present a case of aggressive MM with EMP invading the duodenum, initially presented with massive upper GI hemorrhage and small bowel obstruction. A 67-year-old woman was admitted to our hospital owing to a lack of either gas or feces passage for 3 days. Abdominal distention and vomit with a high coffee ground content were observed for 24 h. The patient’s condition was initially diagnosed as small bowel obstruction, upper gastrointestinal bleeding, severe anemia, acute renal failure, and hypercalcemia. Furthermore, an analysis of immunoelectrophoresis in the blood, bone marrow aspiration, and tissue biopsy supported the diagnosis of MM and EMP invading the duodenum, upper GI hemorrhage, and small bowel obstruction. Our study provided the possible involvement of MM and EMP in the differential diagnosis of patients with unexplained GI hemorrhage and small bowel obstruction. A thorough review of the literature regarding the association between MM, GI hemorrhage, and small bowel obstruction is presented in this study.

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A rare case report of multiple myeloma presenting with paralytic ileus and type II respiratory failure due to hypercalcemic crisis

Abstract: An appropriate diagnostic approach is needed in emergency practice to identify the paralytic ileus and type II respiratory failure caused by hypercalcemia secondary to multiple myeloma.

Cited by 5 publications

References 9 publications

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

The relationship between red cell distribution width, serum calcium ratio, and in-hospital mortality among patients with acute respiratory failure: A retrospective cohort study of the MIMIC-IV database

Duodenal Ulcer with Massive Gastrointestinal Hemorrhage as an Initial Manifestation in Multiple Myeloma with Extramedullary Disease: A Case Report

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