Endocrine Abstracts

A 34-year-old Caucasian male with type 1 diabetes, diabetic nephropathy and secondary hyperparathyroidism was electively admitted for parathyroidectomy. He is on regular peritoneal dialysis and is on the renal transplant list.

On admission his PTH was 215.3 and corrected calcium was 2.01. Other biochemical parameters remained stable. He uneventfully underwent a total parathyroidectomy. No implantation of any of the parathyroid glands was done. He did not receive any vitamin D or oral calcium supplements prior to the surgery. Regular checks of corrected calcium and PTH per-operatively and post operatively were satisfactory, and he was commenced on oral calcium and vitamin D. On the first post-operative day, he complained of peri-oral tingling. His corrected calcium was found to be extremely low at 1.63, with PTH 1.1. He was treated with intravenous calcium gluconate 10% with continuous monitoring of his cardiac rhythm. His corrected calcium remained around 1.5 for two days till he was infused enormous quantities of intravenous calcium gluconate 10%. Over 5 days he received 203 ampoules, i.e. 2030 ml of 10% calcium gluconate.

The postoperative hypocalcaemia probably resulted from acute reversal of the PTH-induced contribution of bone to maintenance of the serum calcium concentration. Our literature search did not reveal any cases requiring such a large amount of intravenous calcium gluconate. This case of hungry bone syndrome could probably have been prevented by pre-treating with vitamin D and calcium supplements and implanting one of the parathyroid glands in the forearm. An alternative to calcium gluconate is intravenous calcium chloride, which is concentrated but irritant to the veins, and therefore better administered centrally.