Cobalt intoxication in a patient with hip prosthesis

• Autores: Carla María Esteban Sánchez, Lourdes Pastó Cardona
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 18, Nº. 3, 2016, págs. 189-190
• Idioma: inglés
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• Resumen

  • In the last years, a new condition derived from the implantation of metal-metal hip prostheses has emerged: arthroprosthetic cobaltism, which represents an intoxication of the patient because of the presence of high serum cobalt levels due to wear and tear of the prosthesis. In our hospital, a case of arthroprosthetic cobaltism presented last year with almost every symptom described in literature: cardiomyopathy, thyroid dysfunction, development of diabetes mellitus, hypertension, neurological symptoms, weakness... Measurements of the serum cobalt concentration of our patient [1,036 μg/L (normal: <2 μg/L)] showed that he was intoxicated by this metal, and were also indicative of articular wear (>10 μg/L). Clinicians decided to replace surgically the hip prosthesis in two stages, which led to a signi􀂿cant improvement of all the symptoms of the patient and the normalization of serum cobalt levels. Besides the surgery, the patient received edetate calcium disodium and acetylcysteine intravenously, as adjuvant treatment. After discharge, he took dimercaptosuccinic acid and acetylcysteine orally during one month. Arthroprosthetic cobaltism is a complication emerging more and more frequently in patients with hip replacement. It is important to identify early the signs and symptoms it can produce. Measurement of serum cobalt levels is an objective way to detect cobalt intoxication and it allows clinicians to start treatment and carry out replacement surgery (if necessary) as soon as possible, to avoid further complications