The Silent Surge: A Case of Rhabdomyolysis-Induced Hypercalcemia

Sep 30, 2026

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The Silent Surge describes a 48-year-old man who initially presented with rhabdomyolysis complicated by acute kidney injury, with laboratory findings consistent with hypocalcemia and related metabolic disturbances. During the recovery phase, he later developed profoundly delayed hypercalcemia marked by severe symptoms including nausea, vomiting, and constipation. Management combined intravenous fluids and diuretics, followed by denosumab, which normalized calcium levels and resolved symptoms. The report emphasizes recognition of an atypical delayed pattern to support accurate diagnosis and appropriate treatment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Case Report

Conclusions

e-ISSN 1941-5923 © Am J Case Rep, 2025; 26: e950626 DOI: 10. 12659/AJCR.950626 Received: 2025.07.09 Accepted: 2025.10.15 Available online: 2025.11.17 Published: 2025.12.25 Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G ABCDEF 1 AE 1 AE 1 ABCDEF 2 Corresponding Author: Financial support: Conflict of interest: The Silent Surge: A Case of RhabdomyolysisInduced Hypercalcemia Moath Fateh Tariq Albweitel Ahmad Odeh Sarah Ghaith Moath Fateh, [e-mail:](e-mail: moathfateh24@gmail.com)[ moathfateh24@gmail.com](e-mail: moathfateh24@gmail.com) None declared None declared 1 Faculty of Medicine, University of Jordan, Amman, Jordan 2 Division of Endocrinology, Diabetes, and Metabolism, University of Kentucky College of Medicine, Lexington, KY, USA Patient: Male, 48-year-old Final Diagnosis: Rhabdomyolysis induced hypercalcemia Symptoms: Nausea • vomiting • constipation Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Calcium is an essential extracellular cation that the body tightly regulates for numerous physiological functions. Rhabdomyolysis typically causes hypocalcemia due to calcium sequestration within damaged muscle tissue. However, in rare cases, it can progress to hypercalcemia, particularly during the recovery phase, often in patients with concurrent acute kidney injury. Case Report: A 48-year-old man with no prior medical or surgical history was admitted to the hospital after he had been found unresponsive at home. His initial toxicology screen revealed the presence of cocaine, fentanyl, and benzodiazepines. He was diagnosed with rhabdomyolysis complicated by acute kidney injury and left upper arm compartment syndrome, requiring emergent fasciotomy and renal replacement therapy. During hospitalization, he developed peritonitis secondary to bowel perforation, which warranted laparotomy. Six weeks later, he presented with nausea, vomiting, and constipation, leading to diagnosis of severe hypercalcemia (serum calcium level, 15.3 mg/dL [reference, 8.9-10.2 mg/dL]; albumin-corrected calcium level, 16.7 mg/dL). The patient received intravenous fluids and diuretics, followed by denosumab, which resulted in normalization of calcium levels and resolution of symptoms. Conclusions: Rhabdomyolysis may initially present with severe hypocalcemia, followed by delayed hypercalcemia due to calcium sequestration and subsequent release from necrotic muscle tissue. In the present case, delayed hypercalcemia was successfully managed with intravenous fluids, diuretics, and denosumab. Recognition of this delayed pattern is critical for accurate diagnosis and appropriate management. Our patient exhibited a particularly delayed presentation of hypercalcemia and displayed an exceptionally high calcium level. Keywords: Rhabdomyolysis • Hypercalcemia • Renal Replacement Therapy • Endocrine System Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/950626](https://www.amjcaserep.com/abstract/index/idArt/950626) 1396 3 3 14 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) e950626-1 Indexed in: [PMC] [PubMed] [Emerging Sources Citation Index (ESCI)][Web of Science by Clarivate] [Fateh M. et](Fateh M. et) al: Exceptionally high calcium level after rhabdomyolysis © Am J Case Rep, 2025; 26: e950626 Introduction Rhabdomyolysis is a clinical syndrome characterized by the brea

FAQs

Why did the patient develop hypercalcemia after rhabdomyolysis?

Rhabdomyolysis can cause calcium sequestration in damaged muscle, typically leading to hypocalcemia; in rare cases, calcium later leaks back into circulation during recovery, resulting in delayed hypercalcemia.

What were the key symptoms when hypercalcemia was diagnosed?

The patient developed nausea, vomiting, and constipation, along with markedly elevated serum calcium and albumin-corrected calcium levels.

How was the delayed hypercalcemia treated and what was the outcome?

Treatment used intravenous fluids and diuretics followed by denosumab, leading to normalization of calcium levels and resolution of symptoms.

Sep 30, 2026

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