Treatment of hypocalcemia in hungry bone syndrome: A case report

“…The HBS was defined as profound hypocalcemia below 8.2 mg/dl and hypophosphatemia that extended beyond the fourth day postoperative (23). In the case of HBS, the patient was treated by intravenous (IV), oral calcium, or both together with active vitamin D (calcitriol) 0.25-1 µg according to patients' requirements until the symptoms of hypocalcemia improved and attain acceptable levels of serum calcium levels (24).…”

Section: Data Collectionmentioning

confidence: 99%

Role of vitamin D supplements in prevention of hungry bone syndrome after successful parathyroidectomy for primary hyperparathyroidism: A prospective study

et al. 2020

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Background: We postulated that the preoperative correction of vitamin D levels can significantly reduce the incidence of hunger bone syndrome among patients undergoing parathyroidectomy for primary hyperparathyroidism. Methods: We performed a prospective, randomized, open-label study on 102 patients with primary hyperparathyroidism and coexisting vitamin D deficiency who were scheduled to undergo parathyroidectomy. Patients were divided into the following two groups: group I which included 52 patients who did not receive preoperative vitamin D supplementation; and group II which included 50 patients who received cholecalciferol 1000–2000 IU daily or 50000 IU weekly until they achieve vitamin D levels >20 ng/mL (group IIa = 25 patients) or vitamin D levels >30 ng/mL (group IIb = 25 patients). Results: The incidence of hunger bone syndrome in group IIb was lower than group I and group IIa (8% versus 16% versus 23%, respectively); however, this difference did not reach the level of statistical significance (p = 0.22). Patients with hunger bone syndrome were significantly younger and had higher serum phosphorus, alkaline phosphatase, magnesium, and bone mineral density at baseline than patients without hunger bone syndrome. On the other hand, patients with hunger bone syndrome had significantly lower 25-hydroxyvitamin D at baseline than patients without hunger bone syndrome (p = 0.001). The ROC curve showed that the baseline level of serum 25-hydroxyvitamin D was not an independent discriminator of hunger bone syndrome (area under curve = 0.21 (95% CI: 0.06–0.34); p = 0.011). Conclusion: Preoperative course of vitamin D supplements has no preventive role on the postoperative incidence of hunger bone syndrome among patients with primary hyperparathyroidism and coexisting vitamin D deficiency undergoing parathyroidectomy.

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“…Hungry bone syndrome (HBS) denotes to the rapid, profound, and prolonged hypocalcaemia with attendant hypophosphataemia and hypomagnesaemia, and is aggravated by lowered parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover [1].…”

Section: Introductionmentioning

confidence: 99%

“…This clinical state usually extends for more than three to four days after a parathyroidectomy. It is argued that HBS is due to the sudden increased calcium influx into the "starved" bone, primed by the decrease of serum parathyroid hormone level (iPTH) post-parathyroidectomy [1]. Hypocalcaemia and HBS are considered either as a postoperative complication or conversely as indicative of a "successful" parathyroidectomy [2].…”

Section: Introductionmentioning

confidence: 99%

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism after Parathyroidectomy: A Case Report

Radu

Daniealopol

Santini

et al. 2019

The Journal of Critical Care Medicine

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Introduction Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphatemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. [1] Case report This report concerns a dialysed patient who underwent surgical treatment for secondary refractory hyperparathyroidism. Haemodialysis was carried out pre-operatively, and subsequently, a total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternocleidomastoid muscle (SCM) was performed. Rapid and progressive hypocalcaemia symptoms developed during the second day postoperatively. Acute cardiac symptoms with tachyarrhythmia, haemodynamic instability and finally asystole occurred, which required cardiopulmonary resuscitation (CPR). The ionic calcium level was 2.2 mg/dL being consistent with a diagnosis of HBS. A second cardiac arrest unresponsive to CPR followed an initial period of normal sinus rhythm. Death ensued shortly after. Before death, the ionic calcium was 3.1 mg/dL. Conclusion HBS, after parathyroidectomy in patients with secondary hyperparathyroidism (SHPT), may be severe, prolonged and sometimes fatal. Generally, HBS symptomatology is that of a mild hypocalcaemia. It can, however, include heart rhythm disturbances with haemodynamic alterations requiring intensive care measurements and even cardiopulmonary resuscitation. A close clinical and laboratory post-parathyroidectomy monitoring of dialysed patients is of the utmost importance.

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Treatment of hypocalcemia in hungry bone syndrome: A case report

Abstract: HighlightsPatients with secondary hyper-parathyroidism experience severe and prolonged hypocalcemia following parathyroidectomy.Pre/postoperative management for HBS helps to minimize long-term effects.No clear set outline for management of HBS, treatment is on case-by-case bases.

Cited by 19 publications

References 9 publications

Hungry bone syndrome after parathyroidectomy: Incidence and predictive factors

Hungry bone syndrome after parathyroidectomy: Incidence and predictive factors

Role of vitamin D supplements in prevention of hungry bone syndrome after successful parathyroidectomy for primary hyperparathyroidism: A prospective study

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism after Parathyroidectomy: A Case Report

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