Hyperphosphatemia, Hypocalcemia, and Transient Renal Failure

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Abstract
Hyperphosphatemia and hypocalcemia following the initiation of cytotoxic therapy of acute lymphoblastic leukemia has been reported.1-3Renal insufficiency of varying degree occurs in this setting.1-2We report a case of severe transient renal failure associated with hyperphosphatemia and hypocalcemia in a patient with acute lymphoblastic leukemia. Report of a Case A 21-year-old man was admitted to The Johns Hopkins Hospital with a one-month history of increasing weakness, dyspnea, intermittent fever with night sweats, and hematemesis associated with epigastric pain. The blood pressure was 100/70 mm Hg; pulse rate was regular at 112 beats per minute; the respirations were 24/min; and the temperature was 37.4 °C. The patient appeared chronically ill. Results of physical examination showed cervical and axillary lymphadenopathy. The lungs were clear to auscultation except for decreased breath sounds at the bases. The abdomen was normal; however, the liver and spleen were enlarged. Neurological examination showed bilateral