Early Hypocalcemia Research Articles

Hypomagnesemia associated with hypocalcemia after total thyroidectomy: an observational study.

Serum magnesium is frequently low in patients with hypocalcemia after total thyroidectomy. The aim of the present study was to analyze the variations in serum magnesium and calcium concentrations after total thyroidectomy, and the relationship between both ions. We conducted an observational study of 142 patients who had undergone total thyroidectomy, measuring serum calcium and magnesium levels preoperatively and on the day following surgery. The incidence of postoperative hypocalcemia was compared with that of postoperative hypomagnesemia. A total of 142, total thyroidectomies were performed: 54 patients (38%) presented with hypocalcemia on the first postoperative day. A marked decrease in blood magnesium in the group of patients with hypocalcemia was observed when compared to those with normal calcemia on the first postoperative day (mean variation respectively, 0.125±0.065mmol/L versus 0.035±0.020mmol/L; P=0.0002). Hypomagnesemia is significantly associated with early hypocalcemia following thyroidectomy.

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

Hypocalcaemia is the most common complication following thyroidectomy. This study aimed to establish the factors associated with increased risk of hypocalcaemia on day 1 following thyroidectomy. All patients who underwent thyroidectomy under a single consultant during a 5-year period were included. A multivariate analysis was undertaken to ascertain which variables had the most effect on the risk of hypocalcaemia. A prognosis table was constructed to allow risk to be predicted for individual patients based on these factors. Included in the analysis were 210 procedures and 194 patients. Eighty-two percent of patients had no calcium derangement postoperatively. Fourteen point nine percent were categorised as early hypocalcaemia, 1% had protracted hypocalcaemia and 2.1% had permanent hypocalcaemia. For hemi-thyroidectomies 2.8% had postoperative hypocalcaemia and 0.9% had permanent hypocalcaemia. The multivariate analysis revealed total thyroidectomy (risk ratio 26.5, p<0.0001), diabetes (risk ratio 4.8, p=0.07) and thyrotoxicosis (risk ratio 3.1, p=0.04) as statistically significant variables for early postoperative hypocalcaemia. Gender as an isolated factor did not reach significance but was included in the model. The p value for the model was p<1×10-12. Total thyroidectomy increases risk of early hypocalcaemia when compared to hemithyroidectomy. Gender, diabetes and thyrotoxicosis were also been found to influence the risk. All of these factors are available pre-operatively and can therefore be used to predict a more specific risk for individual patients. It is hoped that this can lead to better informed consent, prevention and better resource allocation.

Calcium and Phosphorus and the Preterm Infant

The early hypocalcemia observed in preterm infants is common. An increasing degree of asymptomatic hypocalcemia is observed with decreasing gestational age. Treatment is controversial and evidence of benefit is lacking. The intakes of calcium and phosphorus for the preterm infant to achieve adequate bone growth and mineralization are based on the amount acquired by the human fetus during the last trimester of pregnancy. Though normal bone mineralization is difficult to achieve, it is possible to prevent osteopenia/rickets in the preterm infant by maximizing intakes of calcium and phosphorus.

Electrolyte and Mineral Homeostasis After Optimizing Early Macronutrient Intakes in VLBW Infants on Parenteral Nutrition.

The aim of the present study was to evaluate electrolyte and mineral homeostasis in very-low-birth-weight (VLBW) infants who received high protein and energy intakes with a unique standardized parenteral nutrition solution containing electrolytes and minerals from birth onward. Prospective cohort study in 102 infants with birth weight <1250 g. The evolution of plasma biochemical parameters was described during the first 2 weeks of life. During the first 3 days of life, mean parenteral intakes were 51 ± 8 kcal · kg · day with 2.7 ± 0.4 g · kg · day of protein, 1.1 ± 0.2 mmol · kg · day of sodium and potassium, and 1.3 ± 0.2 mmol · kg · day of calcium and phosphorus. Afterwards, most nutritional intakes (parenteral and enteral) met growth requirements. No infant developed a hyperkalemia >7 mmol/L, and a hypernatremia >150 mmol/L occurred only in 15.7% of the infants. In contrast, hyponatremia <130 mmol/L and hypokalemia <3 mmol/L occurred in 30.4% and 8.8% of the infants, respectively. The initial neonatal metabolic acidosis rapidly resolved in most infants and only 2.0% developed a base deficit >10 mmol/L after day 3 of life. Early hypocalcemia <1.8 mmol/L occurred in 13.7% of the infants. In contrast, hypophosphatemia <1.6 mmol/L occurred in 37.3% and hypercalcemia >2.8 mmol/L occurred in 12.7% of the infants. Increasing early protein and energy intakes in VLBW infants in the first week of life improves electrolyte homeostasis. It also increases the phosphorus requirements with a calcium-to-phosphorus ratio ≤1.0 (mmol/mmol) and the potassium and sodium requirements to avoid the development of a refeeding-like syndrome. These data suggest that the parenteral nutrition guidelines for VLBW infants for the first week of life need to be revised.

Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy.

Postoperative hypocalcemia is a common complication of thyroidectomy. Magnesium is known to modulate serum calcium levels and hypomagnesemia may impede correction of hypocalcemia. The purpose of this study was to investigate whether hypomagnesemia after thyroidectomy has any impact on early hypocalcemia and/or permanent hypoparathyroidism. We conducted a retrospective review of prospectively maintained databases. Inclusion criteria were total or completion total thyroidectomy with postoperative magnesium levels available. The incidence of postoperative hypocalcemia was correlated with postoperative hypomagnesemia and other risk factors. Two hundred one cases were included. Twenty-six patients (13%) developed postoperative hypomagnesemia. Hypomagnesemia (p = .002), cancer diagnosis (p = .01), central neck dissection (p = .02), and inadvertent parathyroid resection (p = .02) were significantly associated with hypocalcemia. On multivariate analysis, only hypomagnesemia (p = .005) remained significant. Hypomagnesemia was also a significant predictor of permanent hypoparathyroidism (p = .0004). Hypomagnesemia is significantly associated with early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Magnesium levels should be closely monitored in patients with postthyroidectomy hypocalcemia.

Preoperative serum alkaline phosphatase: a predictive factor for early hypocalcaemia following parathyroidectomy of primary hyperparathyroidism

Preoperative serum alkaline phosphatase: a predictive factor for early hypocalcaemia following parathyroidectomy of primary hyperparathyroidism

Prognostic Value of Complete Blood Count and Electrolyte Panel during Emergency Department Evaluation for Acute Ischemic Stroke

Objective. To determine whether routine laboratory parameters are predictors of early mortality after acute ischemic stroke (AIS). Methods. The cohort consisted of 522 consecutive patients with AIS presenting to the emergency department (ED) at a tertiary referral center during a 27-month period, residing within the surrounding ten counties. Serum laboratory values were obtained for all patients and categorized according to whether the levels were low, normal, or high. These laboratory results were evaluated as potential predictors of 90-day mortality using Cox proportional hazards models. The associations were summarized by calculating risk ratios (RRs) and 95% confidence intervals (CI). Results. The presence of elevated white blood cell count (RR 2.2, 95% CI 1.5–3.4), low bicarbonate (RR 4.2, 95% CI 2.6–6.7), low calcium (RR 2.9, 95% CI 1.4–5.9), and high glucose (RR 1.3, 95% 1.1–1.6) were each univariately associated with significantly higher mortality within the first 90 days. Based on fitting a multivariate Cox regression model, elevated white blood cell count, low bicarbonate, and high glucose were each identified as being jointly associated with early mortality (). Conclusion. Early leukocytosis, acidosis, and hyperglycemia and hypocalcemia in AIS appear to be associated with early mortality. Whether addressing these factors will impact survival remains to be investigated.

Does the pre-operative serum phosphate level predict early hypocalcaemia following parathyroidectomy for primary hyperparathyroidism?

Background and objectivesHypocalcaemia is a significant post-operative complication following parathyroidectomy. Early identification of risk factors can help pre-empt hypocalcaemia and avoid serious sequelae. It can also help identify those patients that are not suitable for day-case surgery. The aim of this study was to analyse the predictive value of the pre-operative serum phosphate level as an indicator for developing hypocalcaemia post-operatively in patients undergoing parathyroidectomy for primary hyperparathyroidism. MethodsWe performed a retrospective review of all patients who underwent parathyroidectomy between 2008 and 2010 at the Southern General Hospital in Glasgow. Data collected included the number of parathyroid glands excised and their histology, pre-operative adjusted calcium (aCa) and phosphate levels, post-operative aCa at 6 and 24 h following surgery, and the fall in aCa levels in the first 6 h and 24 h following surgery. Minitab Statistical Analysis (Version 15) was used for data analysis. ResultsFifty-six patients underwent parathyroidectomy in the study period. Twelve patients were excluded for various reasons including incomplete records and secondary hyperparathyroidism. Patients given calcium or Vitamin D supplements immediately post-operatively were also excluded. Statistical analysis showed no significant correlation between the pre-operative phosphate level and the post-operative decline in aCa level 6 h or 24 h following surgery. ConclusionsPatients with a lower phosphate level pre-operatively were not at risk of a more drastic fall in calcium levels following parathyroidectomy. The pre-operative phosphate level was not found to be predictive of post-operative hypocalcaemia in our study.

Predictors of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism

We sought to identify predictors of development of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism. The patients were divided into two groups according to their serum calcium (Ca) levels within 24 hours of undergoing para-thyroidectomy: the hypocalcemia group (22 patients) with post-operative serum Ca levels of 2 mmol/L or less, and the normocalcemia group (48 patients), with post-operative serum Ca levels higher than 2 mmol/L. By using multivariate stepwise logistic regression analysis, high pre-operative serum Ca level had the strongest predictive value of development of early hypocalcemia with an adjusted odds ratio (aOR) of 3.01, followed by hypo-albuminemia (aOR = 2.72), younger age (aOR = 2.56), and high pre-operative alkaline phosphatase (ALP) levels (aOR = 2.28). We conclude that among patients with secondary hyperparathyroidism, age, levels of pre-operative serum Ca, ALP and albumin correlate positively with the development of early post-operative hypocalcemia. Patients with one of these factors should be monitored more closely in the early post-parathyroidectomy period.

Intraoperative parathyroid hormone as an indicator for parathyroid gland preservation in thyroid surgery

Intra-operative parathyroid hormone (PTH) levels have successfully been used to assess surgical ablation of parathyroid adenomas, the use of this same test to predict preservation of viable gland has not been widely used. to test the sensitivity and specificity of intraoperative rapid PTH assay test in predicting permanent postoperative hypoparathyroidism, and applicability to guide the search for inadvertently removed parathyroid glands for possible auto transplantation. 52 patients undergoing total thyroidectomy for non-malignant thyroid diseases were included. Intraoperative rapid PTH assay test was performed. If levels were reduced, or less than 3 parathyroid glands were detected, removed thyroid gland was examined for unintentionally removed parathyroid tissue for possible auto transplantation. There was a strong correlation between intraoperative rapid PTH assays and those taken 24 hours after surgery, 16 out of 52 patients had reduction of the PTH intraoperatively to levels below 25 pg/ml, of them, 11 patients (who had values between 15-24 pg/ml) recovered to normal PTH levels within 4 weeks, while the 5 patients with intraoperative PTH levels below 15 pg/ml failed to regain normal PTH levels up to 12 weeks postoperatively, even in those patients where parathyroid tissue was auto transplantated. The 4 patients who had parathyroid tissue reimplanted intraoperatively restored some of their parathyroid function as indicated by relative rise of their PTH levels, but did not reach even the low normal levels. (ROC) curve for prediction of early hypoparathyroidism using intraoperative rapid PTH assay was statistically highly significant with optimal cutoff value for predicting early hypocalcaemia level <27 pg/ml, (sensitivity 100%, specificity 68.2%). (ROC) curves for predicting permanent hypoparathyroidism using intraoperative rapid PTH assay or standard PTH assay taken 24 hours after surgery were statistically significant with optimal cutoff value PTH level <12 pg/ml on the intraoperative PTH curve or <15 pg/ml on the postoperative PTH curve (sensitivity 100%, specificity 100%). Intraoperative PTH assay may allow intraoperative monitoring of parathyroid function, predicting postoperative outcomes, may identify patients at risk of developing postoperative hypoparathyroidism, guiding surgeons to re-examine removed specimens for inadvertently removed parathyroid tissue with possible auto transplantation, or more practically a guide to early replacement therapy to prevent hypocalcaemia, leading to safe and early hospital discharge. Limitations in our study to be reconsidered in further studies, are relative small sample size, inability for randomisation, and the variable values reported for the cut off value of PTH causing hypocalcaemic symptoms needing intervention.

Are Low Birth Weight Infants at Risk for Mineral Disturbance in Early Neonatal Period?

Bacground and Aims: The physiological levels of calcium and magnesium are very unstable in the first few days after birth, due to abrupt interruption of placental supply, low level of PTH and high levels of calcitonin, physiological acidosis. Infants with intrauterine growth retardation and preterm birth are at risk for hypocalcemia or hypomagnesemia. Often asymptomatic they can be undiscovered and untreated. There are a lot of controversies in regards with the physiological low limit of calcium and magnesium; are their values, smaller than those which are biostatistic classified, without any clinical and electrocardiographic aspects, physiological or not for ontogenetic age? The aim of these paper is to establish the incidence of early hypocalcemia and hypomagnesemia in low birth weight infants and the risk factors that impose the cases in a screening program. Methods: Calcium and magnesium were determined in 120 newborns (50 term SGA newborns, 50 prematures and 20 AGA newborns), 48 hours after birth. Results: Hypocalcemia was detected in 16% of term SGA with Rohrer index below 1.8 and 16% of prematures with gestational age under 32 weeks and birth weight below 1500g. Hypomagnesemia was detected in 4% of term SGA and 16% of SGA prematures. 4 term SGA have had hypocalcemia and hypomagnesemia. Onely 5 cases of term SGA with hypocalcemia were simptomatic. Conclusions: Low birth weight infants and severe intrauterine growth retardation are high risk factors for mineral disturbance. Screening is usefull in SGA new bornes with low Rohrer index and prematures under 1500g.

Calcinosis Cutis in a Newborn with Transient Pseudohypoparathyroidism

Pseudohypoparathyroidism (PHP) is a heterogenous group of disorders characterized by hypocalcemia with hyperphosphatemia, increased serum concentration of parathyroid hormone (PTH), and insensitivity to the biological activity of PTH. Calcinosis cutis, the cutaneous deposition of calcium salts in the dermis, is a rare clinical symptom in infancy. The deposition of calcium in the skin may be classified as dystrophic, metastatic, idiopathic, and iatrogenic. Although a few infants with PHP and calcinosis cutis have been reported, to the authors' knowledge, the combination of neonatal transient PHP and calcinosis cutis associated with calcium treatment has not been previously reported. The authors report a newborn boy with transient PHP presenting with early hypocalcemia, hyperphosphatemia, increased PTH levels, and calcinosis cutis after intravenous treatment of calcium gluconate.

Predictive Factors for Early Postoperative Hypocalcemia After Surgery for Primary Hyperparathyroidism

The purpose of this study was to identify patients at risk for hypocalcemia after parathyroid surgery. The charts of 99 patients who underwent parathyroid surgery over a 2-year period using a rapid intraoperative parathyroid hormone (IOPTH) assay were retrospectively reviewed. Data for patient demographics, preoperative parathyroid hormone and calcium levels, IOPTH levels, and postoperative calcium levels were reviewed, and trends were analyzed for patients who had postoperative hypocalcemia. Of the 99 patients, 91 had one gland excised and 8 had two glands excised. Preoperative calcium levels ranged from 8.9 to 15.6 mg/dL. Sixty-seven of the patients had a >50% drop in IOPTH at 5 minutes, and 82 had a >50% drop in IOPTH by 10 minutes. Twelve patients had early hypocalcemia. Parathyroid weight and surgery type were not significant factors in predicting postoperative hypocalcemia. A drop of >80% in IOPTH at 10 minutes was a significant factor for postoperative hypocalcemia (P = 0.02). In addition, having normal or only minimally elevated preoperative calcium was an independent risk factor for postoperative hypocalcemia (P = 0.05). Our study has shown that postoperative calcium supplementation and in-hospital monitoring should be considered in patients with a preoperative calcium level in the normal range and with an IOPTH that has dropped by >80%.

A rare cause of neonatal hypocalcemia: malignant infantile osteopetrosis

Malignant infantile osteopetrosis (MIOP) is a rare inherited bone disease characterized by reduced or dysregulated activity of osteoclasts, which results in generalized osteosclerosis. This leads to abnormal bone marrow cavity formation and to the clinical signs and symptoms of bone marrow failure and nerve compression. Symptoms related to early or late hypocalcemia may appear as the first presentation of MIOP in a newborn. We present a 14-day-old boy with neonatal hypocalcaemia due to MIOP.

Hypocalcemia is common in the first 48 h of life in ELBW infants

The incidence of early hypocalcemia in extremely low birthweight (ELBW) infants is unknown because the distribution of serum calcium values in this population is not defined. To determine the range of serum calcium values in ELBW infants during the first 48 h of life and the risks associated with low values. Retrospective analysis of all ELBW infants admitted on day 1 of life from April 2004 to October 2006. Demographic variables, therapy, serum calcium (Ca), pH, albumin, and blood ionized Ca were recorded. There were 381 Ca levels obtained from 111 patients. Mean Ca was 6.90 mg/dL (1.73 mmol/L) (5(th)-95(th) percentile: 5.16-8.80). Ca levels rose after 24 h of life. Almost one quarter (23.1%) of the Ca levels were low by current standards. The majority of subjects (59.9%) had at least one hypocalcemic value. Serum Ca values are lower in ELBW infants and inconsequential. Thus, hypocalcemia should be re-defined for ELBW infants.

Predictors of Recurrent Hyperparathyroidism after Total Parathyroidectomy in Chronic Renal Failure

Background/Aims: Recurrent hyperparathyroidism (HPT) after total parathyroidectomy (TPTX) in chronic renal failure appears more common than might be anticipated. Methods: To study its predictors, we reviewed all 20 cases of TPTX performed at our hospital in a 10-year period. Results: During follow-up (median 46.8 months (range 9.3–120.3)), 15 patients had measurable PTH levels (>10 pg/ml), 7 had levels above the normal range (recurrent HPT), and 3 had PTH levels >300 pg/ml (severe recurrent HPT). Total follow-up post-TPTX was equal in those who developed recurrent HPT and others, but those with recurrent HPT had spent longer on dialysis post-TPTX (61.9 ± 34.9 vs. 21.8 ± 12.0 months; p = 0.001). Patients with recurrent HPT required less vitamin D supplementation during the 10 days post-TPTX (p = 0.025). Log [maximal PTH post-TPTX] correlated with duration of dialysis dependency post-TPTX (r = 0.591, p = 0.006), lowest serum calcium level during the first 30 days post-TPTX (r = 0.449, p = 0.047), and mean serum calcium during the first 30 days post-TPTX (r = 0.546, p = 0.013). Mean log [maximal PTH post-TPTX] was significantly lower in patients with ectopic calcification (p = 0.047). In multiple regression analysis, duration of dialysis post-TPTX and lowest serum calcium level during the first 30 days post-TPTX were the only independent predictors of log [maximal PTH post-TPTX]. Conclusion: Recurrent HPT is common following TPTX and predicted by duration of dialysis dependency post-TPTX, a measure of overall exposure to the uraemic stimulus to parathyroid hyperplasia, and the degree of early hypocalcaemia, possibly reflecting the adequacy of operative parathyroid ablation.

Rhabdomyolysis.

Rhabdomyolysis.

Early Hypocalcemia and Indices of Bone Turnover in Very Low and Extremely Low Birth Weight Infants

Early Hypocalcemia and Indices of Bone Turnover in Very Low and Extremely Low Birth Weight Infants

Early Hypocalcemia and Indices of Bone Turnover In Very Low And Extremely Low Birth Weight Infants 1511

Early Hypocalcemia and Indices of Bone Turnover In Very Low And Extremely Low Birth Weight Infants 1511

Ionized Calcium in the Evaluation of Early Hypocalcemia of Prematurity 1060

Ionized Calcium in the Evaluation of Early Hypocalcemia of Prematurity 1060