SHM Converge Scientific Abstract ePoster Gallery-Hungry Hungry Hip-Bones: Navigating Post-Operative Hypocalcemia

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This case report describes a 31-year-old man with end-stage renal disease on hemodialysis and tertiary hyperparathyroidism who developed hungry bone syndrome after a 3.5-gland parathyroidectomy. He was admitted for post-operative monitoring because he had multiple risk factors for severe hypocalcemia, including young age, markedly elevated pre-op PTH, elevated alkaline phosphatase, bone disease, dialysis dependence, and no significant pre-operative hypercalcemia.<br /><br />Hungry bone syndrome is a potentially life-threatening complication of parathyroidectomy caused by rapid skeletal uptake of calcium, phosphate, and magnesium after removal of the hyperparathyroid state. In this patient, calcium fell to 6.9 mg/dL on post-operative day 0 and required aggressive replacement with intravenous calcium gluconate, oral calcium carbonate, and calcitriol. His management was complicated by fluid overload from continuous calcium infusion, requiring hemodialysis with additional fluid removal. The report highlights that concentrating calcium infusions may help reduce volume overload in dialysis patients.<br /><br />The patient’s calcium gradually improved over the hospital course, but he experienced recurrent hypocalcemia after discharge and readmission. His course also included symptoms consistent with hypocalcemia, such as tingling, numbness, muscle cramps/spasms, and bilateral shoulder pain, which improved as calcium normalized. Alkaline phosphatase peaked around 10 days after surgery, reflecting ongoing bone remineralization.<br /><br />Key takeaways are that hungry bone syndrome should be anticipated in high-risk patients after parathyroidectomy, monitored with frequent labs, and treated with calcium and vitamin D supplementation. In dialysis patients, careful balancing of calcium repletion and fluid status is essential to avoid complications such as fluid overload.

Asset Subtitle

Esther Kuan

Meta Tag

Author List Andrew Young, Esther Kuan

Category Clinical Vignettes

Concept Hungry Bone Syndrome

Concept Hypocalcemia

Concept Calcium Supplementation

Concept Surgical Management

Concept Vitamin Supplementation

Distinguished Non-Finalist

Presenter Organization Western University of Health Sciences

Presenting Author Esther Kuan

Track Adult

Keywords

hungry bone syndrome

parathyroidectomy

hypocalcemia

hemodialysis

tertiary hyperparathyroidism

end-stage renal disease

calcium gluconate

calcitriol

fluid overload

bone remineralization

Hungry Bone Syndrome

Hypocalcemia

Calcium Supplementation

Surgical Management

Vitamin Supplementation