Hyperuricemia and hypocalcemia are common metabolic complications occurring during induction of remission in acute lymphocytic leukemia (ALL) especially in patients with a large mediastinal mass, high WBC count, and massive organomegaly. Recently, we encountered a girl with ALL who developed tetany and renal failure prior to any chemotherapy. To our knowledge, there is no previous report of tetany prior to chemotherapy for treatment of ALL.
Report of a Case.—A 13-year-old girl developed nasal bleeding, easy bruising, malaise, and mild fever about one week prior to admission. On admission, she had a temperature of 39.4 C, a pulse rate of 140 beats per minute, respirations 28 per min, and blood pressure of 98/50 mm Hg. She was alert, but restless. Extensive petechiae and bruises were noted. Liver and spleen were felt 4 and 3 cm below their respective costal margins, but no lymphadenopathy was noted. Fundi were normal. Both Chvostek's