Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Department of Pharmacy, Sengkang General Hospital, Singapore, Singapore.
Int Urol Nephrol. 2020 Mar;52(3):557-564. doi: 10.1007/s11255-020-02387-0. Epub 2020 Feb 3.
Hyperparathyroidism in chronic kidney disease-mineral and bone disorder is associated with significant morbidity and mortality. Parathyroidectomy is widely carried out as treatment despite complications such as hypocalcaemia post-surgery. Our centre has been using an ALP-based protocol to replace calcium postoperatively to prevent hypocalcaemia. We aim to describe and audit our calcium replacement protocol post-parathyroidectomy METHODS: We, retrospectively, analyse 167 end-stage kidney disease patients who had parathyroidectomy with auto-implantation in Singapore General Hospital between January 2008 and December 2013. Their calcium replacement postoperatively was initiated upon patient arrival back in ward on the same day of surgery based on their pre-op ALP prior to occurrence of hypocalcaemia. Patient demographics, surgical and laboratory parameters were reviewed from medical records. Changes in calcium postoperatively were reported to look for incidence of calcium derangement.
Mean calcium levels between pre-operation day and post-operation day 7 ranged from 2.31 to 2.70 mmol/L. Decline in serum calcium was common in all patients prior to starting calcium replacement. Eighteen patients (10.9%) experienced hypocalcaemia immediately post-operation prior to commencement of IV calcium replacement. Patients with immediate post-operation hypocalcaemia had lower pre-operation calcium but higher pre-operation alkaline phosphatase (ALP) and pre-operation intact parathyroid hormone. Hypercalcaemia is common likely from aggressive IV calcium replacement using the protocol. The average length of stay for patients prior to calcium stabilization and discharge was 9 days.
Implementation of an ALP-based prophylactic calcium replacement protocol with daily serum calcium monitoring can ameliorate severe hypocalcaemia post-parathyroidectomy.
慢性肾脏病-矿物质和骨异常中的甲状旁腺功能亢进症与较高的发病率和死亡率相关。尽管手术后会出现低钙血症等并发症，但甲状旁腺切除术仍被广泛应用于治疗。我们中心一直在使用基于 ALP 的方案在手术后替代钙以预防低钙血症。我们旨在描述和审查我们在甲状旁腺切除术后的钙替代方案。
我们回顾性分析了 2008 年 1 月至 2013 年 12 月在新加坡总医院接受甲状旁腺切除术和自体移植的 167 例终末期肾病患者。根据手术前 ALP 值，在同一天患者返回病房后开始进行术后钙替代治疗，直到发生低钙血症。从病历中回顾了患者的人口统计学、手术和实验室参数。报告了手术后钙的变化，以寻找钙紊乱的发生率。
术前日和术后第 7 天的平均钙水平范围为 2.31 至 2.70mmol/L。所有患者在开始静脉补钙前均出现血清钙下降。18 名患者（10.9%）在开始静脉补钙前立即发生术后低钙血症。术后立即发生低钙血症的患者术前血钙较低，但碱性磷酸酶（ALP）和术前完整甲状旁腺激素较高。高钙血症很常见，可能是由于该方案中使用了积极的静脉补钙。在钙稳定和出院之前，患者的平均住院时间为 9 天。
实施基于 ALP 的预防性钙替代方案，并进行每日血清钙监测，可以改善甲状旁腺切除术后严重低钙血症。
