Sorry for the longish title. I was thinking about the movie Witches of Eastwick where the character Felicia breaks her leg. She starts saying bizarre, paranoid things and the doctors explain it away by saying that it’s because the bone marrow has entered the bloodstream and gone to the brain and she’s going to say and do bizarre things but not to worry. In the film it’s probably not because of that explanation but I was curious as to whether that was a real one–can a broken bone result in what the (fictional) doctor was saying?
Long bone fracture can result in fat emboli which, even in the absence of right-left shunts, can make their way to the left-sided circulation and get to the brain. Manifestations of fat emboli to the brain can include confusion and/or stroke symptoms, both temporary and permanent. Depending on which part of the brain is involved, a patient might seem a little wacky. Actual paranoia would be unusual.
Fat emboli to the lungs might cause significant hypoxia and dyspnea, which can present as severe anxiety and a sense of impending doom, and might also result in some nutty behaviour, I suppose.
Thanks, guys. Sounds creepy!
And a related question, I think i remember seeing an issue like this in House M.D. The patient had a broken toe that was leaching calcium into the blood stream. Does anything like that ever happen?
After I broke my femur, I was looking through my bill and one of the drugs I was given in the ER was to reduce calcium in the blood.
Can you tell me which drug, I’ve been in ER 10 years, and never heard of that
Isn’t that part of the plot of “A Separate Peace”? One of the boys has multiple fractures to his leg, with no other ill effects than it takes a long time to heal. Then
at the end he re-breaks it with a simple fracture but the bone marrow gets into his blood stream and kills him.
Probably one of the bisphosphonate class of drugs, such as are listed in the linked Wiki piece (e.g. pamidronate, etidronate, etc.).
Although not terribly common, elevated blood calcium levels (hypercalcemia) can occur as a result of someone being immobilized, especially in the setting of high turnover of bone (i.e. when lots of old bone is being resorbed and new bone is being formed) such as occurs with fractures or in Paget’s Disease. The usual diagnostic term is ‘immobilization hypercalcemia’ if you wanted to search for more information on it.
I’ve been trying to find the hospital bill that had it listed but no luck.
It’s the episode “Frozen” from the 4th season. This medical review says that while the medicine was generally OK, it is usually only bones like the femur that can cause this kind of fat emboli when they fracture. Toe bones aren’t long enough.
Well, don’t stress yourself, I was just curious as I’ve never seen that done, at least in my ER. I’ve treated hypercalcemia in bone cancer cases before, but I haven’t worked on an orthopedic floor where this maybe more common.
It was a drug usually used in cancer treatment. I was looking through the bill just after I came home and what caught my eye was the very high cost for a single dose so I looked it up out of curiosity.
Could it have been Aredia? It is used to reduce calcium levels (and for pain control) in myeloma/certain-cancer patients, and likely has other ‘indications’ afaik.
Maybe that medicine have been a calcium channel blocker, per se?