Complications of Thyroid Surgery
Madan Laxman Kapre in Thyroid Surgery, 2020
Traditionally hypocalcemia was post-operatively identified via serial serum calcium levels checked at regular intervals to determine the need for calcium supplementation. However, serum intact PTH (iPTH) levels have generally superseded this in locations where this is available. The timing of iPTH checks post-operatively to predict consequent hypocalcemia accurately is controversial. Most studies have found that most accuracy at 4 hours post op with a level greater than 10 pg/mL for iPTH and a drop no greater than 50% of the iPTH compared to pre-op levels is a reasonable indicator for adequate surgery [59–61]. Normal post-operative iPTH levels accurately predict normocalcemia after total thyroidectomy, and patients with PTH in the normal range can be safely discharged on an outpatient basis or on the first post-operative day. Regardless of serum calcium levels or iPTH levels, use of oral calcium supplements, either as needed or routinely, will avoid mild symptoms that may develop without treatment, and some advocate this for all their thyroidectomy patients [62].
Antiviral therapeutics for viral infections of the central nervous system
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Foscarnet has been associated with significant renal toxicity, and dose adjustments are necessary when the creatinine clearance is ≤1.4 mL min−1 kg−1. Prehydration with saline has been shown to reduce the incidence of nephrotoxicity, as has avoidance of concurrent nephrotoxic therapy [39,40]. Nephrotoxicity and electrolyte disturbances are the major side effects associated with foscarnet. Serum creatinine elevations of up to three-fold are observed in about half of recipients. Risk factors for renal dysfunction include preexisting renal disease and concurrent use of other nephrotoxic drugs. In addition, factors such as hydration status and manner of infusion also affect nephrotoxicity [41]. Renal toxic effects are typically reversible within 2–4 weeks of discontinuing therapy. Foscarnet is a chelating agent that can cause significant electrolyte abnormalities, including hypo- and hypercalcemia and hypo- and hyperphosphatemia [42]. Hypocalcemia is seen in up to a third of patients, and can result in seizures, tetany, and arrhythmias. Hypomagnesemia and hypokalemia can also occur in some patients. CNS side effects include headache, seizures, hallucinations, tremors, and neuropathies. Other adverse effects include fever, nausea, vomiting, hepatic dysfunction, and cytopenias [1].
Biochemistry
Michael McGhee in A Guide to Laboratory Investigations, 2019
Hypocalcaemia can be due to: hypoparathyroidism (raised phosphate)ricketsosteomalaciachronic renal failuremalabsorptionnephrotic syndrome.
US-guided percutaneous radiofrequency ablation of secondary hyperparathyroidism as a bridge to renal transplantation
Published in International Journal of Hyperthermia, 2023
Wenwen Yue, Tingting Jiang, Erya Deng, Huihui Chai, Ning Weng, Hongfeng He, Zhengxian Zhang, Dong Xu, Chengzhong Peng
All patients with ESRD tolerated the ablation procedure well. Hoarseness occurred in two of the treatments and all recovering within three months spontaneously. Four patients presented with mild to moderate hypocalcemia after treatment, which slowly disappeared with oral calcium supplements during the subsequent period. Serious hypocalcemia occurred in one patient requiring intravenous calcium supplementation. No serious adverse events such as local infection, skin burning, or damage to the vital structures of the neck were observed. No mortality was directly associated with RFA treatment. The median interval from RFA to RTP was 22 months (range 2.5–79 months), and none of the patients was excluded from transplant operation because of PTH values while on the waiting list following RFA treatment.
Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism
Published in Renal Failure, 2020
Kittrawee Kritmetapak, Sawinee Kongpetch, Wijittra Chotmongkol, Yutapong Raruenrom, Sakkarn Sangkhamanon, Chatlert Pongchaiyakul
The international guidelines established by the Kidney Disease: Improving Global Outcomes (KDIGO) organization recommend that ESRD patients with severe SHPT who are refractory to medical therapy, including calcimimetics and active vitamin D analogues, undergo parathyroidectomy [4]. Although parathyroidectomy has been shown to improve renal osteodystrophy, reduce fracture risk, and decrease mortality in patients with SHPT, HBS remains a clinically significant complication following parathyroidectomy [24]. HBS is characterized by a rapid, profound, and persistent hypocalcemia associated with hypophosphatemia, hypomagnesemia, and is exacerbated by an abrupt reduction in serum PTH concentrations, which follows parathyroidectomy in patients with severe hyperparathyroidism and preoperative high bone turnover. Hypocalcemia-related symptoms range from mild (including tingling and muscle cramps) to severe (seizure, cardiac arrhythmia, and overt heart failure, especially in ESRD patients with latent myocardial dysfunction) [25,26]. Therefore, accurate and early identification of SHPT patients at high risk of developing HBS could potentially reduce postoperative complications.
Prolonged QTc Interval in Nigerian Children with Sickle Cell Anemia
Published in Hemoglobin, 2021
Maxwell U. Anah, Anthony C. Nlemadim, Chigozie I. Uzomba, Egorp O. Ineji, Friday A. Odey
There are other established causes of prolonged QTc interval, the majority of which have been excluded in the subjects of this study [8]. One of them is hypocalcemia, which appears to be a constant factor in sickle cell anemia, and together with myocardial ischemia, may be the fundamental reason for the occurrence of prolonged QTc interval in sickle cell anemia unlike in non sickle cell anemia patients with anemia due to other hematological diseases [3,4,21]. Hypomagnesemia also causes prolonged QTc interval by impairing release of parathormone and tissue response to parathormone that leads to secondary hypocalcemia [22]. Therefore, if serum calcium levels were measured in this study, one may have found hypocalcemia in both clinical states similar to that obtained in previous studies [3–7].
Related Knowledge Centers
- Calcium
- Cardiac Arrest
- Iatrogenesis
- Kidney Failure
- Paresthesia
- Vitamin D Deficiency
- Serum
- Spasm
- Seizure
- Hypoparathyroidism