A 58-year-old female with history of end-stage renal disease and hyperthyroidism is admitted to the intensive care unit after a complicated total thyroidectomy with reimplantation of parathyroid glands. Intravenous calcium supplementation is initiated. However, the patient continues to fail her spontaneous breathing trials with inadequate tidal volumes and negative inspiratory force (NIF) of −20 mm Hg. Labs on postoperative day 4 showed continued hypocalcemia despite supplementation and normal parathyroid hormone (PTH) levels.
Which of the following statement regarding her condition is NOT correct?
A. The syndrome most often occurs in patients with chronic increase in bone resorption induced by high levels of PTHCorrect Answer: B
Hypocalcemia is a common problem after parathyroidectomy or thyroidectomy. The acute withdrawal of PTH causes an increase in osteoblast-mediated bone formation and a decrease in osteoclast-mediated bone resorption. Hypocalcemia after surgery is usually transient, as the degree of bone disease is typically mild and normal parathyroid tissue recovers function within a few days. Severe or prolonged hypocalcemia is called the hungry bone syndrome, and most often occurs in patients with chronic increase in bone resorption induced by high levels of PTH or in patients with high bone turnover induced by excess thyroid hormone. Hungry bone syndrome can occur despite normal or even elevated levels of PTH.
Patients with hungry bone syndrome often present with concurrent hypophosphatemia, hypomagnesemia, and hyperkalemia. These imbalances reflect increased bone influx and efflux. Treatment consists of aggressive electrolyte supplementation and may necessitate a continuous infusion of calcium. Severe cases can be managed with dialysis with highcalcium bath.
References