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  • • Depressed serum calcium

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Epidemiology

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  • • Post thyroidectomy or parathyroidectomy

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Symptoms and Signs

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  • • Hyperactive deep tendon reflexes

    • Chvostek sign

    • Muscle/abdominal cramps

    • Carpopedal spasm

    • Convulsions

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Laboratory Findings

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  • • Depressed serum calcium

    • Hypomagnesemia

    • Prolonged QT interval

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  • • Hypoparathyroidism

    • Hypomagnesemia

    • Severe pancreatitis

    • Renal failure

    • Severe trauma

    • Crush injuries

    • Necrotizing fasciitis

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  • • Serum calcium, phosphorus, creatinine, and parathyroid hormone (PTH)

    • 24-hour urine calcium

    • Chest film

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  • • Treat alkalosis if present

    • Acutely: Calcium gluconate

    • Long-term: Vitamin D, oral calcium, phosphate binders

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Medications

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  • • Calcium gluconate

    • -6 g in 500 mL D5W

      -Infuse at 1mL/kg/h

      -Monitor serum calcium and adjust infusion as necessary

    • Vitamin D

    • Oral calcium

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Treatment Monitoring

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  • • Serum calcium

    • Ionized calcium

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Prognosis

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  • • Excellent

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Prevention

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  • • Postoperative calcium surveillance

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References

Forsythe RM. et al. Parenteral calcium for intensive care unit patients. Cochrane Database of Systematic Reviews. 2008, (4):CD006163
Adler JT et al. Preserving function and quality of life after thyroid and parathyroid surgery. Lancet Oncology. 2008, 9(11):1069-75.  [PubMed: 19012855]

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