Incidence Of Hypocalcemia Research Articles

Incidence of hypocalcemia in total thyroidectomy

Background and objectives: Hypocalcemia is a common complication in patients after total thyroidectomy. This study was undertaken to identify risk factors for post thyroidectomy hypocalcemia. To evaluate the risk factors of post total thyroidectomy hypocalcemia, in order to enable early management, avoid complications, and treat accordingly. Method: A longitudinal study was performed from January 2019 to February 2022. All cases of total Thyroidectomy were included which totaled 27. Ionized serum calcium with Parathyroid Hormone, serum, magnesium, serum phosphate and vitamin D were all measured for every patient preoperatively then postoperatively once, and serum calcium was measured every eight hours for the first 48 hours. Results: Our results showed an overall significant difference in the readings of calcium at different times, the mean of pre-operative reading of serum calcium was (9.6 mg/dl), which was greater than the mean of calcium measured 24 hours post-operative that was (8.72 mg/dl) with (p < 0.001), and the incidence of hypocalcemia was 51.9% of hypocalcemia after total thyroidectomy. Parathyroid Hormone level was the only risk factor for developing post total thyroidectomy hypocalcemia (p < 0.001), other risk factors were none of them significant.

Making the Cut: Parathyroidectomy Before or After Kidney Transplantation?

Hyperparathyroidism is common in patients with end-stage kidney disease and may persist after kidney transplantation (KT). Parathyroidectomy (PTx) is curative, but whether PTx should be performed before or after KT remains controversial. There is concern that PTx can adversely affect renal allograft function if performed post-KT and result in persistent hypocalcemia. This study evaluated outcomes and postoperative complications of PTx before and after KT at our institution. We performed a retrospective review of patients at our center (1/2012-2/2019) who had PTx either pre-KT or post-KT. Data on patient demographics, surgical outcomes, and postoperative complications of PTx were collected. Ninety-eight patients were included in this study, with 23 patients undergoing PTx before KT and 75 after KT. The length of follow-up after KT was 67.7 ± 25.5months. In post-KT PTx patients, 30-day allograft function was unchanged after PTx. Calcium oxalate and phosphate crystals were less common on allograft biopsies in pre-KT PTx patients (10.0% vs. 34.8%, p = 0.038). Patients in the pre-KT group required more calcium supplementation after PTx than the post-KT group (p < 0.001). At one-year post-PTx, 17 (19.1%) patients required > 1000mg elemental calcium per day and 7 (7.9%) patients required > 2000mg/day. There was no difference in surgical success or postoperative complications between the two groups. Parathyroidectomy before or after kidney transplantation does not adversely affect allograft function. The incidence of persistent hypocalcemia was low. Parathyroidectomy is safe and effective either before or after kidney transplantation.

The Clinical Characteristics of Electrolyte Disturbance in Patients with Moderate and Severe Traumatic Brain Injury Who Underwent Craniotomy and Its Influence on Prognosis.

The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis. A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis. A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p<0.05), while gender, hyponatremia, potassium, magnesium, intracranial infection, pneumonia, allogeneic blood transfusion, hypertension, diabetes, abnormal liver function, and abnormal renal function were not statistically significant (p>0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05). The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.

Clinical application of regional citrate anticoagulation for continuous renal replacement therapy in children with liver injury.

BackgroundRegional citrate anticoagulation (RCA) is increasingly used for continuous renal replacement therapy (CRRT) in children, but it is rarely used in children with liver injury, especially liver failure (LF). We analyze this issue through the following research.MethodsWe retrospectively analyzed 75 children with liver injury who underwent RCA-CRRT in the Pediatric Intensive Care Unit (PICU) of Children's Hospital of Chongqing Medical University. The patients were divided into the LF group and liver dysfunction (LD) group. The two groups were compared to evaluate the clinical safety and efficacy of RCA-CRRT in children with liver injury and to explore RCA-CRRT management strategies, in terms of the following indicators: the incidence of bleeding, clotting, citrate accumulation (CA), acid–base imbalance, and electrolyte disturbance, as well as filter lifespans, changes in biochemical indicators, and CRRT parameters adjustment.ResultsThe total incidence of CA (TCA) and persistent CA (PCA) in the LF group were significantly higher than those in the LD group (38.6 vs. 16.2%, p < 0.001; 8.4 vs. 1.5%, p < 0.001); and the CA incidence was significantly reduced after adjustment both in the LF (38.6 vs. 8.4%, p < 0.001) and LD groups (16.2 vs. 1.5%, p < 0.001). The incidence of hypocalcemia was significantly higher in the LF group than in the LD group either before (34.9 vs. 8.8%, p < 0.001) or after treatment (12.0 vs. 0%, p < 0.001). The speed of the blood and citrate pumps after adjustment was lower than the initial setting values in both the LF and LD groups. The dialysis speed plus replacement speed were higher than the initial settings parameters.ConclusionFor children undergoing RCA-CRRT, the risks of CA and hypocalcemia are significantly higher in children with liver failure than those with liver dysfunction, but through the proper adjustment of the protocol, RCA-CRRT can still be safely and effectively approached for children with LD and even LF.

Hypocalcemia After Thyroidectomy in Patients with Prior Bariatric Surgery: A Propensity Score Matched Analysis from a National Administrative Database.

Background: Studies have suggested that patients with prior gastric bypass may be at increased risk for hypocalcemia following thyroidectomy. Unfortunately, most of these studies are limited to case reports and small series. This study represents the largest sample size to date to assess the incidence of post-thyroidectomy hypocalcemia in patients with a history of bariatric surgery. Methods: The TriNetX Research Network was queried to retrospectively identify patients with prior bariatric surgery who underwent total thyroidectomy between 2011 and 2021. The incidence of hypocalcemia following surgery was compared with patients who underwent total thyroidectomy, and hemithyroidectomy with no history of bariatric surgery. Results: We identified 446 patients with a history of bariatric surgery and subsequent thyroidectomy, 29,346 patients with total thyroidectomy, and 19,603 patients with hemithyroidectomy alone. The one-month incidence of hypocalcemia was 54.7% in those with a history of bariatric surgery who underwent thyroidectomy, 43.9% in those with thyroidectomy alone (relative risk, RR = 1.2 [confidence interval, CI 1.1-1.4], p < 0.001), and 8.1% in those with hemithyroidectomy only (RR = 6.8 [CI 6.1-7.4], p < 0.001). Permanent hypocalcemia was documented in 11.4% of patients with prior bariatric surgery who underwent thyroidectomy, 7.7% of those with thyroidectomy only (RR = 1.5 [CI 1.1-1.9], p = 0.003), and 2.9% of patients with hemithyroidectomy alone (RR = 3.9 [CI 3.0-5.2], p < 0.001). Significant differences persisted after matching demographics, prior need for supplementation, and risk factors for hypocalcemia after thyroidectomy. When stratified by bariatric procedure, patients with a history of Roux-en-Y gastric bypass (RYGB) (n = 35) had a greater, although not statistically significant, risk of short-term hypocalcemia (51.4%; RR = 1.2 [CI 0.8-1.6], p = 0.37), and a significantly increased risk of permanent hypocalcemia (20.0%; RR = 2.6 [CI 1.3-5.1], p = 0.005) compared with thyroidectomy alone. Sleeve gastrectomy (SG) (n = 40) was not associated with an increased risk of short-term (40.0%; RR = 0.9 [CI 0.6-1.3], p = 0.62) or permanent (7.5%; RR = 1.0 [CI 0.3-2.9], p = 0.96) hypocalcemia. Conclusions: Prior RYGB, but not SG, may increase the risk of permanent hypocalcemia after thyroidectomy. Additional research is necessary to determine optimal prevention and treatment strategies to reduce morbidity in this population.

Incidence of Hypocalcaemia in Term Jaundiced Infants after Phototherapy

Jaundice is one of the main problems in the neonates early in life having an impact on around 60% of full term and 80% of premature infants. Current worldwide date reports that annually, almost 1.1 million neonates go on to suffer from serious neonatal jaundice and large amount of those reside in sub-Saharan Africa and South Asia. The goal of our research is to quantify the incidence of hypocalcaemia in term infants with hyperbilirubinemia who have been treated with phototherapy for 48 hours. Objective And Methodology: This research makes use of a descriptive case series study approach. Data collection was done in the Pediatrics unit 1 services hospital Lahore from six months from Jan, 2022 to July 2022. Patients' basic information (such as their names, ages, sexes, and addresses) was collected during the Study's case registration process. Newborns that met the study's eligibility criteria were given 48 hours of laser treatment. After 48 hours of laser treatment, the serum calcium level was checked and recorded. Results: The average age of the neonates was 8.83±3.99 days. The average birth weights of the newborns were 2.28±0.39 kg. The mean Serum Calcium level at Baseline was 9.33±1.09 mg/dl. The mean Serum Calcium level after 48 hours of laser therapy was 7.64±1.36 mg/dl. There were 30(34.5%) neonates with hypocalcemia and 57(65.5%) neonates without hypocalcaemia in this study. Conclusion: The frequency of hypocalcaemia was moderate 34.5% among neonates with hyperbilirubinemia who received laser therapy. Keywords: Hypocalcaemia, Jaundice, Hyperbilirubinemia, Laser Therapy, Neonatal Jaundice

Effectiveness of prophylactic calcium and vitamin D supplementation for preventing post-thyroidectomy hypocalcemia: a meta-analysis

Background: Postsurgical hypocalcemia is the most common and troublesome consequence of thyroidectomy. We investigated the potential role of routine calcium or vitamin D supplementation in preventing postsurgical hypocalcemia. Methods: We searched MEDLINE and Embase for English-language publications using the keywords “calcium,” “vitamin D,” and “thyroid cancer.” The primary outcome was any postoperative hypocalcemia, and the secondary outcome was symptomatic hypocalcemia. Results: Four studies that included 381 patients were eligible for this meta-analysis. A random-effects model showed no significant difference in the occurrence of hypocalcemia between calcium/vitamin D treatment and placebo/no treatment. However, the occurrence of symptomatic hypocalcemia was lower in patients with calcium/vitamin D treatment. In the combined results, preoperative calcium and vitamin D supplementation were associated with a reduced incidence of symptomatic hypocalcemia. Conclusions: Our findings support the use of preoperative calcium and vitamin D supplementation in conjunction with routine postsurgical supplementation for patients after total thyroidectomy.

TH8.4 The potential for day case total parathyroidectomy in patients with secondary hyperparathyroidism

Abstract Aims Hypocalcaemia is a common complication after parathyroidectomy for secondary hyperparathyroidism (SHPT) and is often the cause of a prolonged hospital stay post operatively. Although there is no current guidance on targets for total parathyroidectomy for SHPT, current guidance recommends a day-case rate of 90% for patients undergoing surgery for primary hyperparathyroidism. Our centre has developed a safe protocol which allows us to perform total parathyroidectomies as a day-case procedure in patients with SHPT. This protocol, developed in conjunction with the renal physicians, involves giving the patients alpha calcidol pre-operatively for 5 days, to minimise the incidence of hypocalcaemia, and close monitoring of the calcium levels post operatively, to permit safe discharge. Methods We carried out a single centre retrospective study on all patients who underwent a total parathyroidectomy for SHPT between February 2005 and May 2021. All the patients received the alpha calcidol regimen pre-operatively. Data on patient baseline characteristics, peri-operative calcium, potassium and PTH levels, length of hospital stay, operative procedure details, hospital readmission and 30-day morbidity were collected. Results 49 patients underwent a total parathyroidectomy during the study period. 67% of patients were discharged on day 0 or on day 1 post-operatively. Reasons for prolonged hospital stay in the remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patients required readmission during the 30-day post-operative period. Conclusion Day-case surgery for SHPT can be achieved safely with a pre-operative regimen of alpha calcidol and close monitoring of calcium levels post-operatively.

The use of near-infrared autofluorescence during total laryngectomy with hemi- or total thyroidectomy.

The aim of this study is to describe the use of near-infrared autofluorescence (NIR-AF) to identify and preserve parathyroid glands (PGs) in a group of patients with advanced hypopharyngeal/laryngeal cancer undergone total (pharyngo)laryngectomy with hemi- or total thyroidectomy. At San Raffaele Hospital, Milan (Italy), from January 2021 to May 2021, 7 patients affected by cT4a laryngeal squamous cell carcinoma (SCC) underwent surgery using an autofluorescence detection system (Fluobeam-Fluoptics®). For proper surgical planning, the demolition phase envisaged extension of the intervention to 4 hemithyroidectomies and 3 total thyroidectomies associated, respectively, with homolateral or bilateral CCND. Serum calcium, ionized calcium, and parathyroid hormone (PTH) levels at post-operative day (POD) 1 and 2 and at 2weeks after surgery were monitored. Finally, we compared the data obtained with a cohort of patients who underwent surgery without the adoption of NIR-AF. With the use of NIR-AF, 18/20 PGs were identified, of which 7/18 were preserved exclusively thanks to the use of autoflorescence. The technique also made it possible to identify and isolate three PGs from the surgical specimen, which were subsequently transplanted only after intraoperative histological confirmation. On POD-1, 3/7 patients (42.8%) were hypocalcemic; on POD-2 and after 2weeks only 1/7 patient (14.2%) was hypocalcemic. Comparing the two groups, we highlighted that the utilization of NIR-AF was related to a significant decrease of median serum (p = 0.026) and ionized calcium levels (p = 0.017) 2weeks after surgery. Using this new technology, in no case did definitive histological examination reveal the presence of PGs in the surgical specimen, reaching an accuracy of 100%. In our cohort of patients who underwent total (pharyngo)laryngectomy with hemi- or total thyroidectomy, the use of near-infrared autofluorescence improved medium term postoperative hypocalcemia rates. This new technology helps to achieve a better calcemic outcome compared to the standard naked eye approach, since it helps the surgeon to identify and preserve parathyroid glandular tissue with a lower incidence of post-operative hypocalcemia.

Morbidities and its Immediate Outcome in Newborns Born Through Mothers with Gestational Diabetes Mellitus

Introduction: Gestational Diabetes mellitus is associated with a significant risk of maternal and neonatal morbidity. Objective: The objective of this study was to assess the different morbidities and their immediate outcome in newborns born to mother with gestational diabetes mellitus. Methods: A descriptive cross-sectional study was done among 349 inborn neonates born to mothers with gestational diabetes mellitus, at the Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences. The informed written consent and ethical approval were taken. The different socio-demographic &amp; clinical parameters of the mothers and neonates were taken. The data was analyzed using relevant statistical tests. Results: Out of the total 11977 deliveries, there were 431 (3.6%) deliveries of mothers with gestational diabetes mellitus. More than half of the neonates were male. The mean birth weight and gestational age of the neonates were 39±2 weeks and 3100 ± 570 gram respectively. Sixty-four (18.3%) neonates had some form of morbidity. The three major morbidities in the neonates were small for gestational age (n=39, 11.2%), preterm birth (n=34, 9.7%) and neonatal hyperbilirubinemia (n=24, 6.9%). The incidence of macrosomia, hypoglycemia, hypocalcemia, polycythemia, cardiac defects, and gross congenital anomalies were 21 (6%), 22 (6.3%), six (1.7%), one (0.3%), eight (2.3%) and two (0.6%) respectively. Similarly, 22 (6%) neonates needed admission, out of which 16 (4.6%) recovered and got discharged, while six (1.4%) expired. Conclusions: The major morbidities associated with neonates born to mothers with gestational diabetes mellitus were small for gestational age, prematurity, neonatal hyperbilirubinemia, and hypoglycemia.

Study of association of serum vitamin D and serum calcium with spontaneous aneurysmal subarachnoid haemorrhage in a tertiary care centre

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a disease associated with high mortality and morbidity. Recent studies have postulated a correlation between Vitamin D deficiency and aSAH, however, the mechanism of which remains obscure. Vitamin D and Calcium in patients withaSAH has not been formally investigated. Therefore, the aim of this study was to evaluate the incidence of hypovitaminosis D and hypocalcemia in patients with aSAH. Methods: An observational study was conducted at the Department of Neurosurgery at tertiary care centre, New Delhi, India. 40 patients with spontaneous aneurysmal SAH were enrolled during the period January 2019 to 15th April 2020. The standard protocol of care was given to all patients included in the study. Laboratory investigations including Vitamin D and Calcium levels; Clinical examination and grading were done for each patient. The data thus collected was used to see the clinic-demographic profile of patients of aSAH with an emphasis on Vitamin D and Calcium levels. Results: The study reported mean vitamin D level of 17.4 ± 7 ng/ml; mean calcium level of 8.3 ± 0.9 mg/dl amongst the study participants. Out of 40 patients, 8 patients (20%) were severely deficient, 24 patients (60%) were mild to moderate deficient and 8 patients (20%) were having normal vitamin D levels. 50% of the patients (n=20) were hypocalcaemic and 50% were normocalcaemic. Conclusion: A higher incidence of vitamin D deficiency was observed in our study along with an equal incidence of hypocalcemia vs normocalcemia. Further studies with a comparison group and a bigger sample size are needed to validate this evidence.

The relationship between chronic kidney disease and denosumab-induced hypocalcemia in high-age osteoporotic patients.

A few studies have reported the safety of the treatment of elderly osteoporotic patients with chronic kidney disease (CKD) and the possibility of hypocalcemia. The aim of the present study was to examine the relationship between the incidence of hypocalcemia and the CKD stage in elderly osteoporotic patients treated with denosumab. This study was designed as a parallel-group comparison study between the denosumab-associated hypocalcemia (DAH) groups: the concentration of serum calcium was under 8.6mg/dl and the normal calcium (NC) groups: the concentration of serum calcium was over 8.6mg/dl. Fifty-two subjects over 70years old were enrolled in this study, with 16 patients classified into the DAH group and 36 patients assigned to the NC group. All patients were further classified into two subgroups according to their age, into an around 75years group to clarify the relevance of old age and an around 85years group and also into a mild CKD group and a moderate CKD group by based on estimated glomerular filtration (eGFR). Serum calcium concentration, tartrate-resistant acid phosphatase (TRACP-5b), and type 1 procollagen N terminal propeptide (P1NP) were measured, and adverse drug reactions were evaluated. The eGFR and serum calcium were significantly lower in the DAH group than in the NC group in the starting phase. Moreover, TRACP-5b was significantly higher in the DAH group than in the NC group in the starting phase. There were no significant differences in P1NP. The incidence of hypocalcemia was significantly higher in the around 85 groups than in the around 75 groups. The frequency of hypocalcemia was also significantly higher in the severe CKD group than in the mild CKD group. Advanced age combined with low eGFR and low serum Ca status appear to be associated with the incidence of hypocalcemia when using denosumab for the treatment of osteoporosis.

Serum Vitamin D Insufficiency in Hospitalized Full-Term Neonates at a Tertiary Hospital in Eastern China.

ObjectiveThis study explored the status of serum vitamin D in hospitalized full-term neonates at a tertiary hospital in eastern China.MethodsA prospective study was conducted among 471 hospitalized full-term neonates at the Children's Hospital of Soochow University between January 1 and June 20, 2020. Perinatal clinical data, serum 25-hydroxyvitamin D (25(OH)D3), laboratory examinations, serum calcium levels, and immune function were obtained and analyzed. We explored and analyzed the risk factors for vitamin D insufficiency or deficiency, and we also attempted to determine correlations between vitamin D and its influence on immunity.ResultsThe mean serum 25(OH)D3 was 33.65±6.07ng/ml.The prevalence of vitamin D insufficiency was 28.24%,vitamin D sufficiency was 71.76%, there was no vitamin D deficiency. The serum 25-(OH)D3 in singleton neonate was higher than twins or multiple infants (t = −10.918, P = 0.000). The serum 25-(OH)D3 were higher in neonates who born in spring and summer than in winter (H = 13.443, P = 0.001). The serum 25-(OH)D3 in appropriate for gestational age (AGA) and large for gestational age (LGA) neonates were higher than small for gestational age (SGA) (H = 7.686, P = 0.021). The serum 25-(OH)D3 were higher in neonates whose mothers had no underlying diseases than those with certain immunological and infectious diseases (F = 12.417, P = 0.000). The serum 25-(OH)D3 in neonates whose mothers had none or one perinatal complication were higher than those with two or more (F = 13.299, P = 0.000). The neonates with eosinophils ≤5% or normal platelet counts or serum Ca++ ≥0.9 mmol/L have higher serum 25-(OH)D3. Neonates born in winter were at risk for vitamin D insufficiency, and the incidence of infectious pneumonia, sepsis, cytomegalovirus infection, and hypocalcemia in the vitamin D insufficiency group were higher than sufficiency group (P < 0.05). The serum CD3+, CD3+CD4+, and IgA levels in vitamin D sufficiency neonates were significantly higher than those in insufficiency group (P < 0.05).ConclusionThe prevalence of vitamin D insufficiency was 28.24%, and birth in winter was a risk factor for vitamin D insufficiency in hospitalized full-term neonates in Suzhou area. Neonates with infectious pneumonia, sepsis, cytomegalovirus infection, and hypocalcemia exhibited a high risk of vitamin D insufficiency. The serum CD3+, CD3+CD4+, and IgA levels in neonates with vitamin D insufficiency were lower.

MO810: Hypocalcaemia Associated with Denosumab Antiresorptive Therapy is Independent of Bone Turnover Biomarkers

Abstract BACKGROUND AND AIMS Background: The incidence of major fractures is increased in the setting of haemodialysis patients. This is related to the decrease in bone density and bone quality and the high prevalence of low bone turnover (LBT). The alteration of calcium-phosphorus metabolism (CKD-MBD), results in a high incidence of cardiovascular disease in patients with multiple comorbidities (inflammation, diabetes). The use of antiresorptive therapy is limited by side effects (hypocalcaemia and LBT). However, it is unclear whether hypocalcaemia is determined by therapy regardless of the prevalence of LBT and comorbidities. Aim: To evaluate the incidence of hypocalcaemia (albumin and mortality adjusted) in a setting of haemodialysis patients yes-therapy (denosumab) versus no-therapy. To evaluate the association of therapy with hypocalcaemia regardless of biomarkers of bone turnover. METHOD From a group of DXA-assessed haemodialysis patients, those who meet the standard eligibility criteria for osteoporosis are undergone on antiresorptive drug denosumab 60 mg every 6 months in subcutaneous administration (yes-therapy group). The remaining DXA-assessed constitutes the control group (no-therapy group), ratio 1: 2. Patients are followed prospectively from the date of execution of the DXA until 30 September 2021. Patients are censored for death or withdrawal of consent. At the DXA date, baseline variables of demographic, biochemical type, related to calcium phosphorus metabolism and DXA, comorbidities are recorded. Prospectively, the levels of calcium, phosphorus, PTH, phosphatase alkaline albumin Hb are recorded every 3 months. Basal therapy of Vit D, P-binders and Ca mimetics was recorded at baseline and could be modified by the doctor on duty for the optimization of parameters Statistical analysis: Data are expressed as mean and SD or as median and range, where required. The outcome is the incidence of hypocalcaemia (&amp;lt;2 quartile = &amp;lt;8.5 mg/dL). Calcium is corrected for albumin and mortality. Calcium adjustment for mortality is achieved by the survival Cox model and a mixed model (calcium as a result variable and random intercept, random slope and fixed effect for time). The slope of the calcemia is informed by the expected longitudinal value at the time of death (informative censoring). Bivariate cox models explore the association between baseline variables (propensity score), comorbidities and biomarkers of bone turnover (mixed model derived) and outcome (joint models). The parameterization of PTH and AF (mixed model derived) is AUC of PTH and of alkaline phosphatase, z-score of PTH and AF beta coefficients. P = .005 is significant. RESULTS Out of 31 DXA-assessed haemodialysis patients, 11 (35%) met the eligibility criteria for denosumab antirabsorptive therapy. In the yes-therapy group, 63% of patients received three subcutaneous doses during the observation period [mean follow-up 226 (179) days]. All-cause mortality did not differ between the yes-therapy versus no-therapy groups (9% versus 25%; P = 0.28). The two groups are homogeneous for all variables except the derived DXA ones. The incidence of hypocalcaemia (&amp;lt;2nd quartile = 8.5 mg/dL) is different for calcium corrected for albumin in the yes-therapy versus no-therapy group (81% versus 46%; P = .02) and for mortality adjusted calcium (81% versus 35%; P = .01). There is no difference in the incidence of hyperphosphorus (&amp;gt;3rd quartile = 5.8 mg/dL). In the JM analysis, denosumab therapy is associated with outcome regardless of biomarkers of bone turnover (PTH and AF) (parameterized as AUC): HR 4 (1.34–11.9); P = .01 and HR 4.88 (1.5–15); P = .006, respectively. Both interactions of PTH and AF with the therapy variable (yes) are not significant. The interaction between therapy and vitamin D is significant [HR 0.04 (0.004–0.40); P = 0.005]. CONCLUSION The incidence of hypocalcaemia is higher in patients on denosumab antiresorptive therapy but this association is independent of bone turnover biomarkers.

Abstract #1184879: Doc! I have an urgent consultation for a patient with severe hypocalcemia and hypomagnesemia

Multiple myeloma (MM) is known to cause accelerated osteoclastogenic and increased bone resorption through Receptor Activator of Nuclear Factor Kappa-B Ligand pathway (RANKL). Denosumab, which is a RANKL inhibitor is commonly used in treating hypercalcemia in these patients. Incidence of hypocalcemia is 8-14% after the administration of denosumab in such patient population. We present a case of severe hypocalcemia and hypomagnesemia in a patient with multiple myeloma and CKD after treatment with Denosumab.

Incidence of Hypocalcemia in Women Suffering from Preeclampsia

Objective: To estimate the incidence of hypocalcemia in women suffering from preeclampsia. Study Design: Cross sectional study. Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Pakistan Railway Hospital Rawalpindi from 1st July 2020 30th June 2021. Methodology: One hundred women with preeclampsia were suffering from high blood pressure and amenorrhea 32 weeks’ pregnant women with parity between 0-5 were enrolled. They were divided in two groups. Group A consisted of normal pregnant women while Group B consisted of pre-eclamptic pregnant women. Blood pressure was taken at three various times using a mercury based sphignomometer. Urine analysis was initially performed as a confirmation of preeclampsia. Serum Calcium levels were determined through calorimetric method using Human Diagnostic kits (Germany). Results: The study highlighted the fact that majority of the pre-eclamptic women such as 54% were educated. There was a significant difference in primigravida of group A and Group B with p value &lt;0.05. Conclusion: Significant association was found between hypocalcemia and preeclampsia among pregnant women. Keywords: Preeclampsia; Pregnancy; Serum calcium levels; Significance

Effect of Phototherapy on Biochemical Markers of Neonates with Unconjugated Hyperbilirubinemia

BACKGROUND&#x0D; Hyperbilirubinemia is one of the commonest clinical problems encountered in the neonatal period, especially during the first week of life which can be classified into unconjugated &amp; conjugated hyperbilirubinemia. Phototherapy plays an important role in the treatment of neonatal hyperbilirubinemia. The study intended to evaluate changes in serum electrolyte levels in neonates undergoing phototherapy for exaggerated physiological hyperbilirubinemia.&#x0D; METHODS&#x0D; A prospective cross-sectional observational study was conducted in a tertiary care teaching hospital from April 2020 to March 2021 on neonates born after achieving gestational age of 28 weeks.&#x0D; RESULTS&#x0D; A significant incidence of hypocalcaemia was noted in neonates post phototherapy (19.2 %; P-value &lt; 0.001). The incidence of hypocalcaemia was higher in preterm (31.7 %) than the term (8.6 %) and at low birth (41.7 %) than in normal-weight (10.6 %). It was also found to be much more when the duration of PTH was &gt; 24 hours (28.6 %) as compared to the duration of PTH when less than 24 hours (12.2 %). No adverse events due to hypocalcaemia were noted. The incidence of hyponatraemia and hypokalaemia after phototherapy was found to be non-significant (P values 0.371 and 0.301 respectively) before and after phototherapy.&#x0D; CONCLUSIONS&#x0D; The study thus does not recommend any calcium supplementation over and above the prescribed guidelines recommended by AAP and NNF. However, in view of higher incidence, LBW and preterm neonates may be considered for monitoring and calcium prophylaxis on an individual basis.

P138 Real-world incidence and management of hypocalcaemia after denosumab administration in patients with chronic kidney disease: a UK secondary-care based audit

Abstract Background/Aims Hypocalcaemia is a recognized complication of denosumab therapy in patients with renal impairment. Our local protocol states that patients with creatinine clearance (CrCl) &amp;lt;35ml/min should have blood tests for calcium and renal function weekly for 4 weeks after each denosumab injection. This audit aimed to assess whether such patients underwent appropriate blood monitoring, and to evaluate the incidence, severity and management of hypocalcaemia in this patient population. Methods Patients who commenced denosumab between 2011 and March 2020 were eligible for inclusion if they had CrCl &amp;lt;35ml/min. Data collection was undertaken through retrospective review of clinical records and pathology systems. Results 53 patients fitting the above criteria were identified. One further patient with eGFR 32ml/min was also included, giving 54 patients in total for analysis. The age range of the patients was 76-97, 9/54 (17%) were male. None were on renal replacement therapy. 29/52 patients (56%) missed one or more post-injection blood tests (incomplete data n = 2). The most commonly missed blood tests were the 1st and 4th weekly checks. 18/54 (33%) developed hypocalcaemia at some point after starting denosumab. In 8/18 this was a one-off episode, but 10/18 experienced recurrent hypocalcaemia. Lowest values for adjusted calcium varied from 1.83-2.18mmol/l. Only 3 patients had a value &amp;lt;2.0mmol/l. Patients who did and did not develop hypocalcaemia had a mean (SD) CrCl of 27.3 (5.03) and 27.8 (5.19) respectively. There was no significant difference in CrCl between these two groups (unpaired t-test, p value 0.7338). Comparing those with &amp;gt;1 episode of hypocalcaemia with the rest of the group, again the mean CrCl was not significantly different (26.6 vs. 27.9, p = 0.47). The three patients who developed more severe hypocalcaemia (adjusted calcium &amp;lt;2.00mmol/l) had CrCl values of 33.2, 24.0 and 21.0ml/min. 17/18 patients who developed hypocalcaemia were on combined calcium and vitamin D supplementation. One patient was on vitamin D3 alone due to intolerance of calcium supplements - they developed mild hypocalcaemia only (nadir 2.13mmol/l) and had CrCl 27ml/min. One patient with CrCl 21ml/min became hypercalcaemic on combined supplementation which was later switched to alfacalcidol by the renal team. Hypocalcaemia was most commonly observed 1-week post-injection, but delayed onset of hypocalcaemia 4-6 weeks post-injection was observed in a few cases. Most episodes resolved within 1-2 weeks, almost all within 4 weeks. One patient died 2 weeks after their 2nd denosumab dose from an unrelated cause - adjusted calcium was 2.16 just prior to death. Additional oral calcium was given in two patients; in one of these, hypocalcaemia recurred after a subsequent injection despite additional supplements, and denosumab was discontinued. Conclusion In a real-world setting, hypocalcaemia after denosumab in patients with reduced renal function (not on renal replacement therapy) is generally mild and rarely requires treatment. Disclosure S.A. Hardcastle: Other; S.H. received conference fee funding from Lilly (UK) in 2018. R. Alshakh: None. J. Webb: None. S. Warren: None. T. Ahmed: None.

A combined nano-carbon tracer and nano-fluorescence assay for parathyroid misresection reduction in thyroid surgery

In recent years, the incidence of nodular goiter and thyroid carcinoma (TC), as well as the amount of surgery, have been increasing simultaneously. To summarize the significance and experience of combined nano-carbon tracer and nano-fluorescence assay for parathyroid misresection reduction in thyroid surgery. The data of patients who underwent thyroid surgery from November 2016 to July 2017 in the Thyroid Disease Diagnosis and Treatment Center of the Tenth People’s Hospital of Tongji University were collected and divided into test group (combined nano-carbon tracer and nano-fluorescence assay method, 80 cases) and a control group (nano carbon tracer method, 80 cases). Comparison of the patient data and preoperative and postoperative blood calcium, blood phosphorus, PTH value in the control and test group was performed. No significant difference was found on gender, age, preoperative Calcium, Phosphorus, Magnesium and PTH, postoperative Calcium, Phosphorus and Magnesium was found in the control and test group (all the p > 0.05), whereas significant difference was found on the postoperative PTH between control and test group (p < 0.001). Moreover, significant reduced number of parathyroid misresection was found in the test group compared to the control group (p = 0.003). Significant difference could be found on pre- and postoperation data of blood Calcium, Phosphorus, Magnesium and PTH in both control and test group (all the p < 0.05). A combined nano-carbon tracer and nano-fluorescence assay can be used in thyroid surgery, which is helpful to distinguish parathyroid tissue, avoid accidental injury or missection of parathyroid gland as much as possible, and reduce the incidence of postoperative hypocalcemia.

Effects of restricted dietary phosphorus supply during the dry period on productivity and metabolism in dairy cows

Phosphorus in bovine nutrition is under ongoing scrutiny because of concerns with excessive amounts of P excreted in manure contributing to environmental pollution. Feeding rations with excessive P content, however, still remains common practice, particularly during the transition period, as limited P supply in late gestation and early lactation is thought to present a risk for health and productivity of high-yielding dairy cows. The objectives of this study were to investigate the effect of restricted P supply during the last 4 wk of pregnancy on Ca and P homeostasis during the transition period in high-yielding dairy cows, and to identify possible effects on metabolism and productivity throughout the following lactation. Thirty late-pregnant multiparous dairy cows were randomly assigned to either a dry cow diet with low (LP) or adequate P (AP) content [0.16 and 0.30% P in dry matter (DM), respectively] to be fed in the 4 wk before calving. After calving all cows received the same ration with adequate P content (0.46% P in DM). Blood, milk, and liver tissue samples were obtained during the dry period and the following lactation, DM intake (DMI), body weight, milk production, and disease occurrence were monitored. Plasma was assayed for the concentrations of P, Ca, Na, and K, metabolic parameters, and liver enzyme activities. Liver tissue was analyzed for mineral, triglyceride, cholesterol, and water contents. Repeated-measures ANOVA was used to identify treatment, time, and treatment × time interaction effects. Cows fed LP had lower plasma P concentrations ([Pi]) than AP cows during restricted P feeding, reaching a nadir of 1.1 mmol/L immediately before calving. After calving, plasma [Pi] of LP cows was at or above the level of AP cows and within the reference range for cattle. Symptoms assumed to be associated with hypophosphatemia were not observed, but plasma Ca was higher from 1 wk before to 1 wk after calving in LP cows, which was associated with a numerically lower incidence of clinical and subclinical hypocalcemia in LP cows. Both treatments had a similar 305-d milk yield (12,112 ± 1,298 kg for LP and 12,229 ± 1,758 kg for AP cows) and similar DMI. Plasma and liver tissue biochemical analysis did not reveal treatment effects on energy, protein, or lipid metabolism. The results reported here indicate that restricted dietary P supply during the dry period positively affected the Ca homeostasis of periparturient dairy cows but did not reveal negative effects on DMI, milk production, or metabolic activity in the following lactation. Restriction of P during the dry period was associated with hypophosphatemia antepartum but neither exacerbated postparturient hypophosphatemia, which is commonly observed in fresh cows, nor was associated with any clinical or subclinical indication of P deficiency in early lactation.