Predictions And Early Treatment Of Postoperative Hypocalcemia In Uremic Patients With Secondary Hyperparathyroidism

Objective To analyze the factors affecting the order of severity of hypocalcemia after parathyroidectomy (PTX) in uremic patients with secondary hyperparathyroidism (SHPT), and summarize the methods of early treatments of patients with the postoperative hypocalcaemia(POH, defined as the occurrence of serum calcium<2mmol/L).Methods Thirty five uremic SHPT patients undergoing PTX within prior3years were retrospectively analyzed. The prevalence, duration and clinical manifestations of POH were recorded. The factors related to the needed average intake of calcium were studied.Results In these patients, The success rate of surgery was88.6%(30/35).POH was found in100%(30/30) of patients, and the occurrence time of POH was3-96h (the median was15h and the interquartile range was16h). The preoperative serum alkaline phosphatase (ALP), intact parathyroid hormone (PTH) and decline of intraoperative PTH were positively related to the needed mean daily intake of calcium.Conclusion To maintain normal serum calcium level in patients with POH (2.0to2.75mmol/L), the mean daily intake of calcium within seven days after surgery should be3.9-65.8mg/kg (the median was38.4mg/kg and the interquartile range was11.37mg/kg). The levels of preoperative serum ALP and PTH and degree of intraoperative PTH reduction can be used to evaluate the severity of POH in these patients. Early and sufficient supplement of calcium and calcitriol are needed in patients at high risk, in order to avoid POH and mitigate symptoms.