Monitoring Of Serum Calcium Research Articles

Association of serum calcium levels with diabetic kidney disease in normocalcemic type 2 diabetes patients: a cross-sectional study

To explore the association between serum calcium levels within normal ranges and Diabetic Kidney Disease (DKD) in type 2 diabetes patients. In this cross-sectional study, we analyzed clinical data from type 2 diabetes patients admitted to the Endocrinology Department of the Affiliated Hospital of Qingdao University from January 1, 2021, to December 1, 2022. We measured serum calcium levels, corrected for albumin, and screened for diabetes-related complications, including DKD. The association between corrected serum calcium levels and DKD was evaluated using logistic regression, with adjustments made for potential confounders and a generalized additive model (GAM) to explore non-linear relationships, supplemented by subgroup analyses. Among the 3016 patients (52.55% male, 47.45% female), the mean corrected serum calcium was 2.29 ± 0.08 mmol/L. DKD was present in 38.73% of patients. A 0.1 mmol/L increase in corrected serum calcium was associated with a 44% increased risk of DKD (OR = 1.44, 95% CI 1.28–1.61, p < 0.0001). The GAM indicated a linear relationship between corrected serum calcium and DKD risk, consistent across subgroups. Corrected serum calcium levels were linearly associated with DKD risk in type 2 diabetes patients, underlining its potential role in risk assessment. These findings emphasize the clinical importance of monitoring serum calcium levels. However, the need for further prospective studies to confirm these findings is underscored by the study’s cross-sectional design.

Association between serum calcium levels and in-hospital mortality in sepsis: A retrospective cohort study

BackgroundThis study examines serum calcium levels and in-hospital mortality in patients with sepsis, a subject with contradictory findings in the existing literature. MethodsThis retrospective cohort study utilized data from the MIMIC-IV database, focusing on adult patients diagnosed with sepsis between 2008 and 2019. The serum calcium levels were taken as the highest value within the first 24 h of Intensive Care Unit (ICU) admission. We performed Cox proportional hazards regression analyses in multivariable-adjusted models to investigate the association between serum calcium levels and in-hospital mortality. Restricted cubic spline functions were used to assess the nonlinear relationship, and threshold effect analysis was conducted to identify potential inflection points. ResultsA total of 18,546 patients with sepsis were included in the study, and an in-hospital mortality rate of 16.9 % (3,126 out of 18,546) was obtained. Furthermore, a U-shaped relationship was observed between serum calcium concentrations and in-hospital mortality, with the lowest point at approximately 8.23 mg/dL. Hazard ratios were calculated as 0.75 (95 % CI: 0.67–0.85, P < 0.001) on the left side and 1.10 (95 % CI: 1.04–1.16, P < 0.001) on the right side of the inflection point. Sensitivity analyses corroborated these results. ConclusionThe research identified a U-shaped correlation between serum calcium concentrations and in-hospital mortality rates among patients with sepsis, underscoring the importance of serum calcium monitoring in this patient population upon hospital admission.

Frequency and determinants of serum calcium monitoring during eldecalcitol therapy in patients with osteoporosis.

Eldecalcitol (ELD) is an active vitamin D3 analog (AVD) commonly used to treat osteoporosis in Japan. Although routine monitoring of serum calcium levels during ELD therapy is recommended, little is known about the actual frequency and determinants of monitoring. This was a descriptive cohort study using a Japanese electronic medical records database. We identified osteoporosis patients who initiated treatment with ELD or other AVDs (alfacalcidol and calcitriol) between April 1, 2011 and September 10, 2021. The index date for cohort entry was the first prescription date of ELD or other AVDs. The frequency of serum calcium monitoring was evaluated every 6 months. Determinants of serum calcium monitoring were identified using multivariable logistic regression models. We also calculated the incidence of hypercalcemia and the frequency of serum calcium monitoring within 6 months before hypercalcemia. We identified 12,671 ELD users and 7867 other AVD users. Within 6 months after cohort entry, 45.9% of ELD users and 58.7% of other AVD users underwent serum calcium monitoring. Female sex, no use of systemic corticosteroids, moderate-to-good renal function, treatment in smaller hospitals, and treatment in orthopedic surgery departments were associated with a lower likelihood of receiving serum calcium monitoring during ELD therapy. The incidence of hypercalcemia among ELD users was 6.36 per 100 person-years, with 20.6% of cases not receiving serum calcium monitoring before hypercalcemia. Our findings suggest that serum calcium monitoring is not given adequate attention during ELD therapy in routine clinical practice.

Lithium-induced parathyroid disease; an updated mini-review

Lithium is a medication commonly used to treat bipolar disorder and other psychiatric conditions. However, long-term use of lithium can lead to parathyroid dysfunction, known as lithium-induced parathyroid disease. The exact mechanism underlying lithium-induced parathyroid disease is not fully understood. Still, it is believed that lithium interferes with the normal function of the parathyroid gland by inhibiting the synthesis and secretion of parathyroid hormone (PTH) and impairing the sensitivity of the parathyroid gland to calcium. The management of lithium-induced parathyroid disease depends on the type and severity of parathyroid dysfunction. In patients with hypoparathyroidism, treatment involves the replacement of calcium and vitamin D supplements. In severe cases, intravenous calcium may be necessary. In patients with hyperparathyroidism, treatment consists in discontinuing lithium therapy and monitoring serum calcium and PTH levels. In situations where hyperparathyroidism persists, or complications like kidney stones or osteoporosis arise, surgery may become necessary.

Hypoparathyroidism – management, information needs, and impact on daily living from the patients’ perspective: results from a population-based survey

PurposeHypoparathyriodism (hypoPT) is a rare endocrine disorder. It is not known how hypoPT is managed in Germany or whether patients have unmet information needs or impairments in their daily living.MethodsHypoPT patients at a minimum of 6 months’ post-diagnosis were invited to participate in an online survey through their treating physician or through patient organizations. An extensive questionnaire, which was developed and pilot-tested with hypoPT patients, was administered.ResultsA total of 264 patients with a mean age of 54.5 years (SD: 13.3), 85.2% female and 92% with postsurgical hypoPT, participated in the study. In total, 74% of the patients reported regular monitoring of serum calcium at least every 6 months, with lower control frequencies for phosphate (47%), magnesium (36%), creatinine (54%), and parathyroid hormone (50%), and 24-h urine calcium excretion (36%) on a yearly basis. Information on symptoms of hypo- and hypercalcemia was available in 72 and 45% of the patients. Information needs were related to the disease and its treatment as well as to nutrition, physical activities/sports, and support opportunities. Statistically significant differences for all information needs in association with symptom burden were observed. Hospitalization for hypocalcemia was reported by 32%, nutritional impairments (38%) or impact on work ability (52%) was available among patients with hypoPT.ConclusionHypoPT patients experience impairments in daily living and report unmet information needs. Patient and physician education regarding hypoPT is one of the key concepts for improving the management of patients with hypoPT.

#3579 AN INITIAL LOW-DOSE ETELCALCETIDE APPROACH IS EFFECTIVE AND COST-SAVING IN HEMODIALYSIS PATIENTS WITH MODERATE SECONDARY HYPERPARATHYROIDISM

Abstract Background and Aims Etelcalcetide (ETC) is an intravenous calcimimetic approved for the management of secondary hyperparathyroidism (sHPT) in hemodialysis (HD) patients, with benefits in terms of reduction of FGF23 levels and prevention of progression of left ventricular hypertrophy. The label recommendation is a starting dose of 5 mg after HD, to be titrated every 4 weeks according to parathyroid hormone (PTH) and calcium levels. However, it remains unclear what dosage is best to start with and, thus, how this treatment can be implemented in a real-life setting. The aim of this study was to assess the efficacy and cost-effectiveness of ETC started at lower doses than those suggested by the manufacturer in patients with moderate sHPT. Methods This is a retrospective observational study comparing two different initial ETC dosing strategies, a “Low-dose approach” (LD, ETC starting dose&amp;lt;10 mg/week) and a “Classic approach” (CL, ETC starting dose≥10 mg/week), in terms of effects on CKD-MBD related biomarkers and costs during the first year of prescription. The study was conducted on HD patients with basal PTH between 500 and 1500 ng/l, treated with ETC for at least 3 months between 2018 and 2022 at ASST Spedali Civili di Brescia. Monthly monitoring of serum calcium, phosphorus and PTH was performed in both groups for dose adjustment. Results Overall, 53 patients were identified, 24 in the LD and 29 in the CL group. Both groups showed similar baseline characteristics (Table 1). Median follow-up was 52 weeks, during which 4 patients (one in the LD and three in the CL group) discontinued ETC (Table 1). At the end of follow-up, 92% of patients in the LD and 90% in the CL group achieved a decrease in PTH ≥30% compared to baseline, with median PTH levels of 282 (207 - 332) and 294 (151 – 382) ng/l, respectively (p = 0.825). Other CKD-MBD biochemical parameters were comparable between the two groups at all timepoints (Figure 1). The median of average ETC weekly doses per patient was 7.6 (6.2 – 10.2) mg in the LD and 10.6 (9.7 – 15) mg in the CL group (p&amp;lt;0.001). During follow-up, the median ETC dose remained stable in the LD group, while partially decreasing in the CL group (Figure 1). Use of paricalcitol was comparable in both groups. At cost analysis, the median of average ETC weekly costs per patient was €36.6 (29.6 – 50.0) in the LD and €50.5 (46.4 – 71.7) in the CL group (p&amp;lt;0.001). This translates into an average yearly cost per patient of €1909 and €2635 using the LD and CL approach, respectively, with a saving of €726 per patient-year in favour of the LD strategy. Conclusion In this retrospective study in HD patients with moderate sHPT, we showed that starting ETC at a lower dose than the one suggested by the manufacturer is as effective as the classic approach in terms of control of CKD-MBD parameters, with a significant reduction in treatment costs. Future prospective studies will be needed to validate the results in bigger cohorts, test whether these benefits can extend beyond the first year of treatment and assess the effects on FGF23 levels and other relevant clinical outcomes.

#6037 VALUE OF ARTERIAL CALCIFICATION DETECTED BY UPPER LIMB DOPPLER ULTRASOUND IN ADVANCED CHRONIC KIDNEY DISEASE

Abstract Background and Aims Vascular calcification is a common complication of chronic kidney disease (CKD), particularly in end-stage-renal disease (ESRD) and is predictive of subsequent cardiovascular disease and mortality. The aim of the present study was to evaluate the relationship between arterial calcification assessed by doppler ultrasound (DUS) performed by the same observer and biochemical parameters of CKD-MBD as well as the standard-of-care therapy for CKD-MBD. Method We present a retrospective study of 454 patients who were evaluated by DUS for pre-surgical vascular mapping from 2018 to 2021. Both arms brachial, radial and cubital arteries were analyzed, and vascular calcification was classified as absent, mild or moderate/severe (presence of acoustic shadowing). Laboratory serum analysis of PTH, serum Calcium (sCa), serum phosphorous (sPi) and serum magnesium (sMg) were collected (with a maximum interval of 6 months from DUS evaluation). Mortality was also registered during follow-up period. Results The demographics and biochemistry of the study population are summarized in Table 1. Arterial calcification was observed in 91.6% (n = 416) of the patients, 62.3% (n = 259) had mild calcification and 37.7% (n = 157) presented moderate/severe calcification. In univariate analysis, male gender (OR 2.2, p &amp;lt; 0.023), age (OR 1.03, p &amp;lt; 0.003), phosphate binders (OR 0.55, p value &amp;lt; 0.03) and cinacalcet use (OR 0.28, p &amp;lt; 0.019) were independently associated with the presence of arterial vascular calcification. Presence of vascular calcification on DUS was associated to mortality. In patients with vascular calcifications, moderate/severe calcification was associated with diabetes mellitus (OR 2.85, p&amp;lt;0.000), male gender (OR 1.69, p &amp;lt; 0.012), PAD (OR 2.43, p &amp;lt;0.001) and hemodialysis therapy for more than 5 years (OR 3.00, p&amp;lt; 0.010). Cinacalcet, phosphate binders, serum calcium, phosphorous, PTH and mortality did not correlate with calcification severity. In the multivariate logistic regression analysis adjusted to age, gender, PAD and serum calcium and magnesium, we found that serum PTHi (OR 1.00, p&amp;lt;0.040), hemodialysis for more than one year (OR 4.44, p&amp;lt; 0.040) and diabetes mellitus (OR 3.95, p&amp;lt; 0.001) were associated with moderate/severe vascular disease. Conclusion Concerning CKD-MBD related markers our study showed that only phosphate binders and cinacalcet use were predictive of absence of vascular calcifications, however no causality could be advanced with these data. For serious calcification, in our multivariable model, only PTH had statistical significance. It is widely recognized the importance of monitoring serum PTH, calcium and Pi to reduce the adverse clinical events associated with CKB-MBD. Widespread implementation of DUS in pre-surgical mapping for VA construction is also an opportunity for vascular study and features as calcifications can be a surrogate of CKD-MBD and cardiovascular burden.

Prevalence of hypocalcemia in term newborns requiring phototherapy

Background: Neonatal hyperbilirubinemia in the first week of life is one of the most prevalent clinical entity observed, affecting 60% of term-babies and 80% of preterm newborn babies, many requiring intervention in the form of phototherapy. The effect of phototherapy on serum calcium levels has not been studied much in Indian literature. The objectives of this study was to evaluate the prevalence of hypocalcemia in healthy, term newborn babies receiving phototherapy for unconjugated hyperbilirubinemia and to determine the association, if any between serum calcium and birth weight, postnatal age at start of phototherapy, weight at enrolment, gestational age at birth, maternal age and duration of phototherapy. Methods: This was a prospective observational study conducted over a period of 10 months among 80 term neonates admitted to the inpatient department at a tertiary care centre in Mumbai. Total serum calcium and ionised calcium levels were measured at the start of phototherapy and on stopping phototherapy/discharge. Data were analysed using statistical package for social sciences (SPSS) version 21 software. Results: Two (2.5%) out of the 80 neonates were found to have hypocalcemia after phototherapy with serum ionic calcium levels less than 1 mmol/l. Even though a larger proportion of neonates showed a decrease in the serum total calcium (56.25%) and serum ionic calcium (58.75%) levels after phototherapy, none of the neonates developed symptomatic hypocalcemia at those levels. A statistically significant association was found between maternal age in years with the serum total calcium levels after phototherapy and age at starting phototherapy (in hours) with the serum ionic calcium levels after phototherapy. Conclusions: The present study concludes that there is significant decrease in the levels of ionised calcium after phototherapy, however there was no significant decrease in the total serum calcium levels and none of the neonates were symptomatic. Hence, we do not recommend regular serum calcium monitoring in healthy term neonates receiving phototherapy and find no indication for the prophylactic use of calcium supplementation in these neonates.

Abstract #1406989: Outcomes of Hypoparathyroidism in Pregnancy: A Retrospective Analysis from a Canadian Tertiary Center

Hypoparathyroidism (HypoPT) is a rare endocrine disorder. If not managed optimally during pregnancy, it may result in maternal and fetal morbidity in the form of miscarriage, preterm delivery, fetal skeletal demineralization, fetal respiratory distress, and fetal death. We, retrospectively reviewed 7 women with chronic HypoPT (both postsurgical and non-surgical) with a total of 16 pregnancies occurring between 2012 to 2022. Clinical and metabolic data as well as fetal and maternal outcomes for both groups are presented in the results. The rate of C-sections in pregnancies complicated by HypoPT was higher than that recorded for the Canadian population in 2019, 43.7% vs.29.9%, respectively. The rate of C-sections was higher in the postsurgical group (p=0.041). Women with nonsurgical HypoPT had a higher rate of preterm delivery compared to the postsurgical cohort, 71% vs. 22% (p=0.02). In fact, the overall rate of preterm delivery in the Canadian population in 2014 was 7.8%, and higher during the pandemic at 7.9%. Women with nonsurgical HypoPT had a higher rate of hospital admission due to hypocalcemia (28% vs. 11%). Preeclampsia affects an estimated 4.6% of pregnancies worldwide, and it affected nearly 13% of our cohort. In our retrospective analysis of pregnancies complicated by chronic HypoPT, we document a high prevalence of neonatal and maternal morbidity despite close monitoring of serum calcium throughout pregnancy aiming for a normal serum corrected calcium.

Iatrogenic endocrine complications of lithium therapy

Lithium is a cation, similar to sodium and potassium, affecting ion transport. It is used in the medical field as a treatment of bipolar disorders. The main endocrine complications of lithium treatment affect thyroid and parathyroid glands, in association with renal complications. Thyroid adverse effects, which are more frequent in women, comprise hypothyroidism, goiter, or sometimes hyperthyroidism, through interference with the iodine symporter. The increase in thyroid volume is early. Prevalence of goiter is 4 times higher than in the general population and hypothyroidism (8–20%) more frequent in case of pre-existing thyroid autoimmunity. Hyperthyroidism likely to worsen mood is reported in 5% of cases but the causal link to lithium is unproven. An increase in serum calcium and PTH occurs in 30% of cases, as lithium stimulates parathyroid cell proliferation by activating the Wnt pathway. The risk of hyperparathyroidism, by adenoma and especially by hyperplasia, is 5 times higher than in the general population, with the particularity of frequent low urine calcium by action on the calcium-sensing receptor (CaSR). Renal complications include risk of acute or chronic renal failure and nephrogenic diabetes insipidus, which is a factor for hypernatremia and hypercalcemia through dehydration. Nephrogenic diabetes insipidus is not always reversible after lithium therapy discontinuation. Metabolically, weight gain can be observed, but rather less than with other psychotropic drugs, and lithium does not in itself induce diabetes. At pituitary level, corticotropic activation is frequent, but implicating the disease rather than lithium. Lithium treatment induces little or no hyperprolactinemia. Regular monitoring of serum calcium, the ionogram, creatinine and TSH is recommended in lithium treatment.

PSAT201 Hypoparathyroidism (HypoPT) in 16 Pregnancies in 7 Patients: A Case Series of Maternal and Neonatal Outcomes

Abstract Background We present biochemical and clinical outcomes from 16 pregnancies in 7 patients with HypoPT. Case1 35y.o postsurgical HypoPT diagnosed(Dx) age27. Pregnancy1(P1): c-section(CS) at 34wks due to pre-eclampsia, BW 1995g with normal APGARS. Admitted for maternal hypercalcemia in 3rd trimester(T3). P2: abortion at 24wks (Trisomy21). P3: CS at 39wks, BW 2993g, calcium(Ca) requirements increased in T3 and decreased while breastfeeding(BF). Case2 39y.o postsurgical HypoPT Dx age34. P1: miscarriage at 8wks. P2: premature uterine contractions in T2 but was carried out to 40wks. Requirements decreased (Ca 44%,calcitriol 33%) due to hypercalcemia and hyperphosphatemia. P3: CS at 40wks. Both P2 and P3 complicated by neonatal hypercalcemia and hyperparathyroidism for 6mo. then recovered. Case3 32y.o postsurgical HypoPT, CS at 39wks, no neonatal complications, BW 3910g.Cae4: 32y.o postsurgical HypoPT Dx age24. P1: preterm at 33+4wks 2nd to PPROM, BW 2550g, normal APGARS. NICU x15 days for nutritional support. Maternal hypercalcemia in T2 (TUMS for GERD). Hypocalcemia and hypomagnesemia in T3 required IV replacement and doubling of Ca and calcitriol requirements. BF for 2mo., requirements decreased (Ca 60%,calcitriol 50%). P2: 28wks pregnant, requirements increased in T1 (Ca 18%,calcitriol 100%). Case5 30y.o GATA3 mutation confirmed age30 with bilateral deafness and CKD. P1: preterm at 36+5wks, BW 2850g. In T3, requirements decreased (Ca 25%, calcitriol 70%). Ca requirements unchanged while BF for 12mo. P2: miscarriage at 8wks. P3: CS at 35+6wks, pre-eclampsia, BW 3190g, APGARS 9/9 according to midwife, required NICU for respiratory distress at 10mins. Calcitriol decreased 66% at T2/T3 vs baseline. Postpartum hypocalcemia required 3X increase in Ca. Case6 31y.o idiopathic HypoPT Dx age22. P1: IVF required induction at 36wks for SGA, BW 1814g. Requirements increased during pregnancy (Ca 4%,calcitriol 150%) and decreased (Ca 10%,calcitriol 20%) while BF. P2: 6wks pregnant, Ca requirements unchanged. Case7 24y.o autosomal dominant hypocalcemia type1 (ADH1) Dx age 18mo. P1: induced at 37wks for "abnormal fetal doppler", BW 2825g, NICU x2wks for hypocalcemia 2nd to ADH1, normal APGARS. Ca and calcitriol requirements increased 3X in T2. Ca requirements declined to baseline, and calcitriol declined by 50% in T3. Required 3 admissions for hypocalcemia. P2: CS at 34wks for low BPP 2/8, APGARS 7/9, BW 2540g, required NICU for hypocalcemia. Required doubling of calcitriol in T1. Requirements increased in T2(Ca 50%,calcitriol 20%) and required 2 admissions for hypocalcemia. Requirements decreased during lactation (Ca 50%,calcitriol 60%). Conclusion Although our case series of pregnancy in HypoPT is relatively small, we document a high prevalence of neonatal and maternal morbidity despite close monitoring of serum calcium throughout pregnancy aiming for a normal serum corrected calcium. Poor compliance contributed to poor outcomes. Women with nonsurgical HypoPT had a higher rate of preterm delivery (4/5 deliveries) vs (2/5). Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

P022 Audit of vitamin D and calcium level monitoring in sarcoidosis patients taking calcium and/or vitamin D supplements

Abstract Background/Aims Sarcoidosis is a chronic inflammatory disorder, for which steroids are a common treatment. A side effect of long-term steroid therapy is an increased risk of osteoporosis, and calcium and/or vitamin D supplementation may be indicated. In sarcoidosis patients, increased expression of 1α-hydroxylase triggers the conversion of 25(OH)D3 to 1,25(OH)2D3 (calcitriol). Therefore, monitoring of calcium and vitamin D levels are recommended for patients taking supplementation, as they are at increased risk of hypercalcemia. Methods We conducted a retrospective analysis on community measurements of serum calcium and vitamin D levels, in sarcoidosis patients, who were prescribed calcium and/or vitamin D supplementation. Patients with biopsy confirmed sarcoidosis were identified using the King’s College Hospital sarcoidosis database and electronic primary care records were reviewed for each patient. Results The database identified 431 patients with biopsy confirmed sarcoidosis, of whom 102 patients (24%) had been prescribed calcium and/or vitamin D supplementation and were further evaluated. Of these 102 patients, 63 (62%) were taking calcium and vitamin D supplementation simultaneously; and 39 (38%) were taking vitamin D supplementation alone. In the last 12 months, 46 patients (45%) had measurements of serum calcium and vitamin D levels taken in the community. One patient taking vitamin D supplementation was identified as having hypercalcemia. Conclusion This audit has found infrequent monitoring of serum calcium and vitamin D levels over the last 12 months, in sarcoidosis patients, who were prescribed calcium and/or vitamin D supplementation. A Clinical Commissioning Group wide prescribing alert has been implemented to alert primary care physicians to the importance of monitoring these levels, to reduce the risk of hypercalcemia. Disclosure S. Gunawardana: None. D. Nagra: None. K. Bechman: None. S. Birring: None. J. Galloway: None. A. Patel: None.

Phototherapy induced hypocalcemia in neonatal hyperbilirubinemia and correlation of hypocalcemia with the duration of phototherapy

Background: Neonatal hyperbilirubinemia is common morbidity in the first week of life. Approximately 5-10% of them requires intervention like phototherapy and even exchange transfusion. Phototherapy has various adverse effects and hypocalcemia is one of them. Thus assessment of serum calcium levels after phototherapy should be done in neonates with jaundice. Background: Neonatal hyperbilirubinemia is common morbidity in the 1st week of life. Approximately 5-10% of them requires intervention like phototherapy and even exchange transfusion. Phototherapy has various adverse effects and hypocalcemia is one of them. Thus, assessment of serum calcium levels after phototherapy should be done in neonates with jaundice. Objectives were to study prevalence of hypocalcemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcemia with duration of phototherapy.Methods: This was a prospective observational study conducted over a period of 18 months among 75 neonates (both term and preterm) in the neonatal intensive care unit of Manipal teaching hospital, Pokhara. Total serum calcium level was measured at 0 hours (control), 12 hours, and after 48 hours and data were analyzed using statistical package for social sciences version 21.Results: Hypocalcemia was found only in term neonates (n=8; 14%). Of those who had hypocalcemia, the majority experienced hypocalcemia after 48 hours of starting phototherapy. The mean difference of total serum calcium level before and after phototherapy in preterm and term neonates was found to be statistically significant. Hypocalcemia was not found to be associated with the duration of phototherapy.Conclusions: The present study concludes that though there is a reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.

Subcutaneous fat necrosis of newborn - A rare case report of lobular panniculitis in a neonate

Subcutaneous fat necrosis of newborn is a rare cutaneous disorder affecting neonates. It usually presents as subcutaneous nodules or plaques, within the first few weeks of life, following an eventful delivery. It is characterized by hypercalcemia, which may present with lethargy, irritability, hypotonia and dehydration, mimicking sepsis. Histopathology is proven to be the gold standard in diagnosis with characteristic lobular panniculitis, mixed inflammatory cell infiltrate and radially arranged crystals. This needs to be differentiated from other causes of lobular panniculitis, as early diagnosis and treatment to prevent long‑term complications are advocated. Education of parents regarding the disease and danger signs of hypercalcemia and weekly monitoring of serum calcium is recommended. Treatment based on rehydration, dietary vitamin D and calcium restriction, Furosemide and prednisolone are considered. We have discussed a case of subcutaneous fat necrosis, in an 8-week-old male baby.Key Messages: Subcutaneous fat necrosis is an important differential in neonates presenting with palpable subcutaneous nodules, along with sclerema neonatorum. Severe complications like hypercalcemia should be detected early and managed aggressively to prevent morbidities and mortalities associated with it. Symptomatic management, use of calcium lowering drugs and regular monitoring of calcium levels are recommended.

A comparative study of serum electrolytes, calcium and phosphorus levels in end stage renal disease patients undergoing hemodialysis

End stage Renal Disease (ESRD) represents the terminal stage of Chronic Kidney Disease (CKD) stage 5 where in there is accumulation of toxins, fluid and electrolytes which are normally excreted by the kidneys resulting in the uremic syndrome which leads to death unless the toxins are removed by renal replacement therapy, using dialysis or kidney transplantation. To estimate and compare the serum levels of electrolytes, calcium and phosphorus in ESRD patients before and after hemodialysis sessions.Cross sectional study conducted on 70 ESRD diagnosed patients, aged 30-75years of either gender on maintenance Hemodialysis. Blood samples were collected before and after Hemodialysis, analysed for Serum Electrolytes by semi autoanalyser from Roche. Serum Calcium and Phosphorus using Cobas Integra 400 plus from Roche for which Internal and External Quality Assurance Programmes are maintained. The data obtained was analysed using statistical package SPSS 20 version. The parameters are compared using paired‘t’ test, the test of probability less than 0.05 (P &amp;#60; 0.05) considered as statistically significant. There is significant decrease in mean serum Potassium, Chloride and Phosphorus, significant increase in serum Calcium and no change in serum Sodium after hemodialysis.Thus from our study we conclude that monitoring serum electrolytes, calcium and phosphorus have prognostic significance in ESRD patients undergoing hemodialysis.

Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management.

Background: Parathyroid disease is uncommon in pregnancy. During pregnancy, multiple changes occur in the calcium regulating hormones which may make the diagnosis of primary hyperparathyroidism more challenging. Close monitoring of serum calcium during pregnancy is necessary in order to optimize maternal and fetal outcomes. In this review, we will describe the diagnosis and management of primary hyperparathyroidism during pregnancy. Methods: We searched MEDLINE, CINAHL, EMBASE and Google scholar bases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters and clinical guidelines were included in this review. Conclusions: Medical management options for primary hyperparathyroidism during pregnancy are severely limited due to inadequate safety data with the various potential therapies available, and surgery is advised during the 2nd trimester of pregnancy in the presence of severe hypercalcemia (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dL)). Hypercalcemia should be avoided during pregnancy in order to minimize maternal and fetal complications.

Retrospective Comparative Study of the Incidence of Hypocalcaemia in Total Thyroidectomy between Ain-Shams University as a Referral Center and Damanhour Medical National Institute

Abstract Background: Post-operative hypocalcaemia is one of the most serious complications of total thyroidectomy with variable degrees of morbidity. Aim of Study: The aim of this study was to to compare the incidenceandto examine several preoperative and imme-diate post-operative factorsfor development of hypocalcaemia after total thyroidectomy in patients who underwent total thyroidectomy in Ain-Shams University and Damanhour Medical National Institute. Patients and Methods: This retrospective study was conducted in Ain-Shams University Hospital and Damanhour Medical National Institute in the period between December 2015 and December 2019. It included 62 patients who under-went total thyroidectomy. The data was collected from patients' files in the Record Department. Results: There were 52 female and 10 male patients. The mean age was 38 years. Multi-nodular goiter was the most common indication of total thyroidectomy. The mean pre-operative serum Ca was 8.1mg/dl in group A and 8.3mg/dl in group B. 3 (9.7%) patients in group A and 7 (22.5%) in group B developed post-operative hypocalcemia. The highest fre-quency of transient hypocalcaemia was on 2nd post-operative day in group A and on 0 day in group B. There was only one patient 3.2% who required calcium and vitamin D supplement for more than six months. Conclusion: Hypocalcaemia is one of the major concerns following total thyroidectomy that can be prevented by me-ticulous surgical technique, identification and preservation of parathyroid glands and its vascularity. Post-operative monitoring of serum calcium & early treatment can prevent significant morbidity.

Effect of Gentamicin on Urinary Calcium Creatinine Ratio and Serum Calcium in Neonates

Introduction: Gentamicin was associated with an apparent increase in the number of neonates with symptoms of hypocalcemia, including seizures. Aim of the study: This study aimed to assess the effect of gentamicin on calcium /creatinine ratio in urine and serum calcium in neonates. Methods: This case-control study included 100 children, divided into two groups. Group I: Fifty neonates received gentamicin. Group II: Fifty neonates did not receive antibiotics at all (control group), Serum calcium and urinary calcium/creatinine ratio, were done at 1st day of admission, and at day 3 and 6 of aminoglycosides therapy. Results: On admission, serum calcium showed a non-significant difference between both groups, P-value was 0.453. On the 3rd day, serum calcium was significantly lower in cases compared to controls with P-value was Conclusion: Gentamicin was associated with decreased serum calcium and increased urinary calcium excretion on 3rd day and 6th day of treatment, so cautious and proper monitoring of serum calcium is mandatory in neonates treated with gentamycin.

Prolonged Hypocalcemia After a Single Dose of Denosumab in Chronic Kidney Disease

Introduction: Denosumab, a monoclonal antibody that inhibits RANK L (receptor activator nuclear factor-kappa beta ligand), is one of the few medications that can be used to treat osteoporosis in patients with chronic kidney disease (CKD). However, its use is associated with a much higher incidence of hypocalcemia in this patient population. What remains unclear is the duration of hypocalcemia after denosumab use. We describe a case of prolonged hypocalcemia of 9 months in a patient with CKD after a single dose of denosumab. Case: A 64-year-old Caucasian man with a history of bilateral lung transplant for interstitial pulmonary fibrosis and CKD Stage IV was referred to the Endocrinology clinic for evaluation of steroid-induced osteoporosis. Bone density scan was consistent with osteoporosis with the lowest T-score of -2.8 at the left femoral neck, which showed a 25.3% decline from a previous one two years prior. His labs upon initial visit: 25 hydroxy Vitamin D: 36.5 ng/mL (30–100), 1, 25 hydroxy vitamin D 32 pg/ml (19.9–79.3), corrected Serum Calcium 8.9 mg/dL (8.5–10.5), Serum Cr 4.38 mg/dL (0.6–1.4), PTH 157 pg/mL (10–65), Serum Alkaline Phosphatase 61 Units/L (25–125), Urine NTX 39 nM BCE/mM creatinine (21–83). After discussing risks and benefits, he was given a dose of subcutaneous denosumab 60 mg. He had been started on Calcium/Vitamin D (600 mg/400 IU BID) prior to receiving his dose. Keeping in mind the increased risk of hypocalcemia given his history of CKD, his corrected serum calcium was checked one week later, and it was 6.5 mg/dL. The patient was asymptomatic. However, given the severity of his hypocalcemia, he was started on calcitriol 0.25 mcg oral BID and calcium carbonate 1200 mg daily. He did show mild improvement in three days to a corrected calcium of 7.0 mg/dL. His calcitriol was briefly increased to 0.5 mcg BID and calcium carbonate was increased to 1800 mg daily. The regimen was weaned to calcitriol 0.25 mcg daily and previous calcium/Vitamin D dosing later that month. Thereafter, his labs were monitored regularly and there were several unsuccessful attempts made to decrease the calcitriol/calcium carbonate. Given persistent hypocalcemia, other bloodwork including a bone specific alkaline phosphatase and celiac screen were checked which were unremarkable. Finally, nine months after his denosumab dose, calcitriol was discontinued safely. Serum calcium levels have remained stable thereafter. Given prolonged hypocalcemia, it was decided not to administer another dose of denosumab. Conclusion: Patients with CKD who receive denosumab are not only at risk for developing severe, but also prolonged hypocalcemia. Therefore, it is imperative to monitor serum calcium levels, not only immediately after receiving a dose, but serially.

Hypoparathyroidism in Pregnancy and Lactation: Current Approach to Diagnosis and Management

Background: Hypoparathyroidism is an uncommon endocrine disorder. During pregnancy, multiple changes occur in the calcium-regulating hormones, which may affect the requirements of calcium and active vitamin D during pregnancy in patients with hypoparathyroidism. Close monitoring of serum calcium during pregnancy and lactation is ideal in order to optimize maternal and fetal outcomes. In this review, we describe calcium homeostasis during pregnancy in euparathyroid individuals and also review the diagnosis and management of hypoparathyroidism during pregnancy and lactation. Methods: We searched the MEDLINE, CINAHL, EMBASE, and Google scholar databases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters, and clinical guidelines were included in this review. Conclusions: During pregnancy, rises in 1,25-dihydroxyvitamin D (1,25-(OH)2-D3) and PTH-related peptide result in suppression of PTH and enhanced calcium absorption from the bowel. In individuals with hypoparathyroidism, the requirements for calcium and active vitamin D may decrease. Close monitoring of serum calcium is advised in women with hypoparathyroidism with adjustment of the doses of calcium and active vitamin D to ensure that serum calcium is maintained in the low-normal to mid-normal reference range. Hyper- and hypocalcemia should be avoided in order to reduce the maternal and fetal complications of hypoparathyroidism during pregnancy and lactation. Standard of care therapy consisting of elemental calcium, active vitamin D, and vitamin D is safe during pregnancy.