scholarly journals Impact of intercurrent illness on calcium homeostasis in children with hypoparathyroidism: a case series

2017 ◽  
Vol 6 (8) ◽  
pp. 589-594 ◽  
Author(s):  
A Chinoy ◽  
M Skae ◽  
A Babiker ◽  
D Kendall ◽  
M Z Mughal ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Calcium Homeostasis ◽  
Calcium Supplementation ◽  
Case Series ◽  
Close Monitoring ◽  
Oral Calcium ◽  
Calcium Supplements ◽  
Intercurrent Illness ◽  
The Impact

Background Hypoparathyroidism is characterised by hypocalcaemia, and standard management is with an active vitamin D analogue and adequate oral calcium intake (dietary and/or supplements). Little is described in the literature about the impact of intercurrent illnesses on calcium homeostasis in children with hypoparathyroidism. Methods We describe three children with hypoparathyroidism in whom intercurrent illnesses led to hypocalcaemia and escalation of treatment with alfacalcidol (1-hydroxycholecalciferol) and calcium supplements. Results Three infants managed with standard treatment for hypoparathyroidism (two with homozygous mutations in GCMB2 gene and one with Sanjad-Sakati syndrome) developed symptomatic hypocalcaemia (two infants developed seizures) following respiratory or gastrointestinal illnesses. Substantial increases in alfacalcidol doses (up to three times their pre-illness doses) and calcium supplementation were required to achieve acceptable serum calcium concentrations. However, following resolution of illness, these children developed an increase in serum calcium and hypercalciuria, necessitating rapid reduction to pre-illness dosages of alfacalcidol and oral calcium supplementation. Conclusion Intercurrent illness may precipitate symptomatic hypocalcaemia in children with hypoparathyroidism, necessitating increase in dosages of alfacalcidol and calcium supplements. Close monitoring is required on resolution of the intercurrent illness, with timely reduction of dosages of active analogues of vitamin D and calcium supplements to prevent hypercalcaemia, hypercalciuria and nephrocalcinosis.

The Management of Post-Thyroidectomy Hypocalcemia

1996 ◽  
Vol 75 (9) ◽  
pp. 612-616 ◽  
Author(s):  
Lisa Szubin ◽  
Ashutosh Kacker ◽  
Rajesh Kakani ◽  
Arnold Komisar ◽  
Stanley Blaugrund
Keyword(s):  
Calcium Phosphate ◽  
Serum Calcium ◽  
Critical Period ◽  
Serum Calcium Level ◽  
Calcium Supplementation ◽  
Serum Magnesium ◽  
Postoperative Hypocalcemia ◽  
Oral Calcium ◽  
Calcium Supplements ◽  
Symptomatic Hypocalcemia

Postoperative hypocalcemia was studied in 40 patients undergoing total thyroidectomy for a malignancy or massive goiter. Parameters evaluated included serum calcium, phosphate and magnesium levels. All patients exhibited a postoperative decline in serum calcium, however, the lowest serum calcium level was not seen until 48 hours after surgery. Serum calcium levels returned to normal in five to six days after surgery in 37 patients. Five patients required calcium supplementation for either symptomatic hypocalcemia or serum calcium levels lower than 7.0 mg/dl. Only three of these five patients were discharged home on oral calcium supplements. In this series, we discovered that the critical period for monitoring of serum calcium was 24 to 96 hours after surgery. If serum calcium replacement was not needed in the first 72 hours after surgery, it would not be needed during the remainder of the patient's hospital course. In addition, we found that serum magnesium levels should also be monitored in the postoperative period and corrected if low.

scholarly journals Hypoparathyroidism in Pregnancy and Lactation: Current Approach to Diagnosis and Management

2021 ◽  
Vol 10 (7) ◽  
pp. 1378
Author(s):  
Dalal S. Ali ◽  
Karel Dandurand ◽  
Aliya A. Khan
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Calcium Absorption ◽  
Case Reports ◽  
Case Series ◽  
Close Monitoring ◽  
Active Vitamin ◽  
Diagnosis And Management ◽  
Active Vitamin D ◽  
Pregnancy And Lactation

Background: Hypoparathyroidism is an uncommon endocrine disorder. During pregnancy, multiple changes occur in the calcium-regulating hormones, which may affect the requirements of calcium and active vitamin D during pregnancy in patients with hypoparathyroidism. Close monitoring of serum calcium during pregnancy and lactation is ideal in order to optimize maternal and fetal outcomes. In this review, we describe calcium homeostasis during pregnancy in euparathyroid individuals and also review the diagnosis and management of hypoparathyroidism during pregnancy and lactation. Methods: We searched the MEDLINE, CINAHL, EMBASE, and Google scholar databases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters, and clinical guidelines were included in this review. Conclusions: During pregnancy, rises in 1,25-dihydroxyvitamin D (1,25-(OH)2-D3) and PTH-related peptide result in suppression of PTH and enhanced calcium absorption from the bowel. In individuals with hypoparathyroidism, the requirements for calcium and active vitamin D may decrease. Close monitoring of serum calcium is advised in women with hypoparathyroidism with adjustment of the doses of calcium and active vitamin D to ensure that serum calcium is maintained in the low-normal to mid-normal reference range. Hyper- and hypocalcemia should be avoided in order to reduce the maternal and fetal complications of hypoparathyroidism during pregnancy and lactation. Standard of care therapy consisting of elemental calcium, active vitamin D, and vitamin D is safe during pregnancy.

scholarly journals 25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D, and Peripheral Bone Densitometry in Adults with Celiac Disease

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 929 ◽  
Author(s):  
Carolina Ciacci ◽  
Giancarlo Bilancio ◽  
Ilaria Russo ◽  
Paola Iovino ◽  
Pierpaolo Cavallo ◽  
...  
Keyword(s):  
Vitamin D ◽  
Celiac Disease ◽  
Serum Calcium ◽  
Calcium Supplementation ◽  
Quantitative Computed Tomography ◽  
Gluten Free Diet ◽  
Gluten Free ◽  
Mineral Density ◽  
High Fracture ◽  
Calcium And Phosphorus

Background: Adults with celiac disease (CeD) show low bone mineral density (BMD) and high fracture risk. CeD guidelines suggest measurements of serum minerals and vitamin D. However, studies on vitamin levels in CeD patients are contradictory. Aim: To investigate in CeD, 25-hydroxy-vitamin D [25(OH)D], 1,25-dihydroxy-vitamin D [1,25(OH)2D], and related analytes and to evaluate their relationships to peripheral BMD as assessed by peripheral quantitative computed tomography (pQCT). Methods: Gluten-free diet (GFD)-treated, and untreated adult CeD patients naïve to vitamin D and calcium supplementation underwent measurements of serum 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), total calcium, phosphate, and of radius BMD by pQCT. Results: Complete data were collected in 105 patients for lab tests and 87 patients for BMD. For lab tests, untreated CeD differed from treated CeD for 22.0% lower serum 25(OH)D (p = 0.023), 42.5% higher serum PTH (p < 0.001), and 13.0% higher serum 1,25(OH)2D (p = 0.029) in the presence of similar serum calcium and phosphorus (p > 0.35). For BMD, untreated CeD differed from treated CeD for lower diaphyseal cortical BMD (1133 and 1157 mg/cm3, p = 0.004) but not for distal BMD (total, trabecular, and subcortical, p > 0.13). Independent correlates of diaphyseal cortical BMD were GFD treatment and body mass index (p < 0.05). Conclusions: Data indicated that, compared to CeD patients on a gluten-free diet, untreated adult CeD patients at diagnosis had lower 25(OH)D, higher PTH, and higher 1,25(OH)2D in the absence of difference in serum calcium and phosphorus. 25(OH)D and 1,25(OH)2D, even below the normal range, were not associated with BMD. Our findings do not support the use of vitamin D supplementation for all CeD adults.

Calcium-Alkali Syndrome Associated with Hypoparathyroidism Following Total Thyroidectomy

2020 ◽  
Vol 51 (2) ◽  
pp. 160-167
Author(s):  
Sayaka Kuroya ◽  
Masahiko Yazawa ◽  
Yugo Shibagaki ◽  
Naoto Tominaga
Keyword(s):  
Vitamin D ◽  
Renal Impairment ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Metabolic Alkalosis ◽  
Calcium Supplementation ◽  
Parathyroid Autotransplantation ◽  
High Calcium

Background: Patients with permanent postsurgical hypoparathyroidism, a complication of total thyroidectomy, often require high calcium supplementation with vitamin D to maintain serum calcium levels. The epidemiology of calcium-alkali syndrome (CAS) in patients with hypoparathyroidism after total thyroidectomy remains unclear. This study aimed to investigate the incidence of hypercalcemia, renal impairment, metabolic alkalosis, and CAS in patients treated for presumed hypoparathyroidism after total thyroidectomy. Methods: Twenty-seven patients with neck cancers who underwent total thyroidectomy without parathyroid autotransplantation between January 2010 and October 2013 at our hospital were consecutively included. All patients received calcium lactate and alfacalcidol for postsurgical hypocalcemia. We defined hypercalcemia as a corrected serum calcium level (cCa) ≥10.5 mg/dL, metabolic alkalosis as a difference in serum sodium and serum chloride ([sNa-sCl]) ≥39 mEq/L, and renal impairment as a ≥50% increase in serum creatine and/or ≥35% decrease in estimated glomerular filtration rate (eGFR) compared to baseline. Results: cCa peaked (11.1 ± 1.5 mg/dL) at a median of 326 days (interquartile range 78–869) after surgery. At peak cCa, [sNa-sCl] was significantly higher (p < 0.01), and eGFR was significantly lower (p < 0.01) than that at baseline. Fifteen patients (55.6%) had hypercalcemia, 19 (70.3%) had alkalosis, 12 (44.4%) had renal impairment, and 9 (33.3%) had CAS. Patients with CAS (mean age 67.1 ± 10.8 years) were older than those without CAS (56.7 ± 13.6 years, p = 0.06). The mean dose of alfacalcidol in the CAS group (3.1 ± 1.2 μg/day) was significantly larger than that in the non-CAS group (2.1 ± 1.0 μg/day, p = 0.03). Conclusions: This retrospective study reveals the high incidence of CAS in patients with hypoparathyroidism after total thyroidectomy. Furthermore, these findings suggest that the serum calcium level, acid-base balance, and renal function should be closely monitored in patients with postsurgical hypoparathyroidism who receive large doses of active vitamin D.

scholarly journals Changes in Serum Concentrations of Fibroblast Growth Factor 23 and Soluble Klotho in Hemodialysis Patients after Total Parathyroidectomy

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Shang-Chih Liao ◽  
Sin-Hua Moi ◽  
Fong-Fu Chou ◽  
Cheng-Hong Yang ◽  
Jin-Bor Chen
Keyword(s):  
Vitamin D ◽  
Growth Factor ◽  
Fibroblast Growth Factor ◽  
Serum Calcium ◽  
Fibroblast Growth Factor 23 ◽  
Hemodialysis Patients ◽  
Clinical Parameters ◽  
Fibroblast Growth ◽  
Calcium Supplements ◽  
Vitamin D Analogue

Background. We examined the changes in circulating fibroblast growth factor 23 (FGF23) and Klotho concentrations in hemodialysis patients after parathyroidectomy (PTX). Methods. We enrolled a cohort of hemodialysis patients who received PTX. Postoperatively, patients received calcium supplements and/or vitamin D analogue (calcitriol) to maintain serum calcium within 7.0–8.0 mg/dL. Information on clinical parameters including bone-mineral metabolic variables was collected pre-PTX and on days 5 and 90 after PTX. Concomitantly, serum full-length FGF23 and α-Klotho levels were measured. The relationship between FGF23 and clinical parameters was analyzed by single linear regression. Results. Forty-six participants (33 women; 13 men) were enrolled in the study. Their mean age was 56.49 years. Serum FGF23 and α-Klotho concentrations were elevated on days 5 and 90 after PTX compared to baseline (p>0.05). Serum FGF23 concentrations negatively correlated with serum calcium concentrations pre-PTX (Beta -0.31; R2 0.0949; p=0.040), day 5 post-PTX (Beta -0.31; R2 0.0982; p=0.036), and day 90 post-PTX (Beta -0.39; R2 0.1528; p=0.008). Conclusions. There was no change in circulating FGF23 and Klotho concentrations after PTX in hemodialysis patients given postoperative calcium supplements and/or vitamin D analogue. Serum FGF23 concentrations pre-PTX and at days 5 and 90 after PTX were inversely related to serum calcium concentrations.

scholarly journals A case report on over-replacement of oral calcium supplements causing acute pancreatitis

2014 ◽  
Vol 96 (1) ◽  
pp. 1-2 ◽  
Author(s):  
V Pronisceva ◽  
J Sebastian ◽  
S Joseph ◽  
E Sharp
Keyword(s):  
Acute Pancreatitis ◽  
Literature Search ◽  
Calcium Supplementation ◽  
Case Reports ◽  
Oral Calcium ◽  
Calcium Supplements ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department ◽  
Upper Abdominal

A 42-year-old female teetotaller presented via the accident and emergency department with a 2-day history of vomiting and upper abdominal pain. She was diagnosed with acute pancreatitis. The aetiology of the pancreatitis was identified as hypercalcaemia secondary to oral calcium supplementation. The hypercalcaemia was corrected by stopping calcium supplements and aggressive fluid resuscitation. A thorough literature search did not show any case reports in which the aetiology of pancreatitis was oral calcium supplement over-replacement.

scholarly journals 5 DAY CONTINUOUS DOSING WITH ORAL NANO VIT.D3 – A CASE SERIES

2021 ◽  
Vol 8 (7) ◽  
pp. 1-4
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Case Series ◽  
Serum Vitamin D ◽  
Severe Vitamin ◽  
Vitamin D Levels ◽  
The Impact ◽  
Continuous Dosing ◽  
Very High

Vitamin D is highly essential for various functions of human body including proper immunity. Deficiency of vitamin D is mostly undetected and also a major underlying cause for various diseases and disorders .The Prevalence of Vitamin D deficiency in India is very high, detection and immediate management of severe vitamin D deficiency is an essential step especially given the current situation of the COVID 19 Pandemic where proper immunity is an important factor for survival. This case series is an update on the impact of 5 day continuous dosing with oral Nano Vit.D3 on serum vitamin D levels in individuals with severe vitamin D deficiency without co-morbidities

scholarly journals Changes in bone metabolic parameters following oral calcium supplementation in an adult patient with vitamin D-dependent rickets type 2A

2017 ◽  
Vol 64 (6) ◽  
pp. 589-596 ◽  
Author(s):  
Yuka Kinoshita ◽  
Nobuaki Ito ◽  
Noriko Makita ◽  
Masaomi Nangaku ◽  
Seiji Fukumoto
Keyword(s):  
Vitamin D ◽  
Adult Patient ◽  
Calcium Supplementation ◽  
Metabolic Parameters ◽  
Oral Calcium

scholarly journals Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India

2021 ◽  
Author(s):  
Hein Aung ◽  
Kyaw Soe ◽  
Frank F. Smithuis ◽  
Thomas Lamb ◽  
Moe Wint Aung ◽  
...  
Keyword(s):  
Vitamin D ◽  
Bone Mineralization ◽  
Calcium Supplementation ◽  
Case Series ◽  
Calcium Deficiency ◽  
Elevated Alkaline Phosphatase ◽  
Hydroxyvitamin D ◽  
Nutritional Rickets ◽  
25 Hydroxyvitamin D ◽  
Childhood Condition

Rickets is an often-neglected, painful, and disabling childhood condition of impaired bone mineralization. In this case series we describe a cluster of 29 children with severe, painful bone deformities who live in the very remote region of Nagaland in northwest Myanmar. Children were found to have low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of the two. After treatment with vitamin D3 and calcium carbonate, significant improvement was seen in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in more than 120 years. Vitamin D and calcium supplementation, and food fortification for pregnant women and young children may be required to prevent this potentially devastating disease.

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