Severe Hypocalcemia and Transient Hypoparathyroidism After Hyperthermic Intraperitoneal Chemotherapy

Abstract

Dear Editors,Hypocalcemia is not unusual in patients hospitalized for critical illness and has also been described after general surgery in addition to head and neck surgical procedures 1 2 3. Hypocalcemic events commonly occur in the setting of massive blood transfusion, albumin deficiency, vitamin D deficiency, and/or hypomagnesemia. In the absence of these factors, only slight decreases in calcium levels within the normal range have been reported during surgical procedures 1. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) causing asymptomatic hypocalcemia has only been reported in two previous studies 4 5. The etiology is unclear. We here report a patient who developed severe symptomatic hypocalcemia likely as a result of a profound inflammatory reaction with transient hypoparathyroidism after HIPEC.

Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers

“… DiSano et al (2019) found that the rates of hyperglycemia in patients undergoing CRS and HIPEC are high, which likely represent a stress response, but do not appear to adversely affect long-term outcomes or hospital stays. Tharmalingam et al (2020) reported that a patient with severe symptomatic hypocalcemia after HIPEC likely suffered from a profound inflammatory reaction with transient hypoparathyroidism, which led to symptoms of significant neuromuscular excitability. In the study by Stewart et al (2018) , most patients (86%) suffered from intraoperative hyperglycemia, with values up to 651 mg/dL.…”