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Clinical Cases in mineral and bone metabolism

Acute severe diarrhoea and hyponatremia after zoledronic acid infusion: an acute phase reaction

Case report, 101 - 104
doi: 10.11138/ccmbm/2017.14.1.101
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Abstract
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Zoledronic acid (ZA), an intravenous aminobisphosphonate, is prescribed widely for postmenopausal osteoporosis.
It is a relatively safe drug but may cause adverse effects including acute phase reaction. Oral nonaminobisphosphonates are known to cause diarrhoea that is usually mild and self-limited. Intravenous aminobisphosphonates are not known to cause diarrhoea. We
describe a case of acute watery diarrhoea complicated by severe hyponatremia and hypotension following ZA infusion. The patient needed intensive care for four days. To the best of our knowledge, this type of acute diarrhoea
complicated by severe hyponatremia, following
ZA infusion, is not reported so far. Strong temporal relation with ZA administration makes it the most likely cause. Furthermore, all laboratory and imaging parameters indicate that the secretory diarrhoea may be a component
of acute phase reaction. According to World
Health Organization (WHO) causality scale, ZA was a probable cause of acute watery diarrhoea in our patient.
Clinicians should be aware that ZA administration can cause acute watery diarrhoea and may lead to severe hypotension and hyponatremia.

Vol. XV (No. 1) 2018 January - April

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