Hypoparathyroidism

Listen to Audio

clinical causes
clinical manifestations
diagnosis
treatment
anesthetic management

Clinical causes:

-MCC parathyroidectomy

Clinical manifestations:
(primarily from decreased Ca2+)

CNS: dementia, depression, psychosis
CVS: hypotension, ECG changes (prolonged QT interval), CHF
NMJ: muscle weakness

Diagnosis:

-decreased [Ca2+]

Primary hypoparathyroidism:
-decreased PTH
-decreased [Ca2+]

Treatment:

Initial dose:
-Calcium Chloride 10% 3-5 ml which provides 272 mg Ca2+
-Calcium Gluconate 10% 10-20 ml which provides 93 mg Ca2+
subsequent doses:
-either repeat bolus as needed
-or continuous infusion 1-2mg/kg/hr

Anesthetic management:

CVS:
decreased [Ca2+] may lead to:
-hypotension: therefore avoid cardiodepressant anesthetics
-ecg changes: prolonged QT interval. Avoid citrate products (ex. blood)
-heart failure

Resp:
-avoid respiratory alkalosis
-hyperventilation will worsen preexisting hypocalcemia

Fluids/Electrolyes:
-avoid 5% albumin solution
-further reduces [Ca2+]