scholarly journals Intensive calcium monitoring improves outcomes on hungry bone syndrome in hyperparathyroidism

2021 ◽  
Vol 55 (1) ◽  
pp. 30-41
Author(s):  
Joana Lima Ferreira ◽  
Francisca de Brito Marques ◽  
Ligia Freire ◽  
Virginia Soares ◽  
Luisa Guerreiro ◽  
...  
Keyword(s):  
Intermediate Care ◽  
Protocol Implementation ◽  
Standardized Protocol ◽  
Hungry Bone Syndrome ◽  
Surgical Ward ◽  
Before And After ◽  
Risk Patients ◽  
Time Frames ◽  
Hungry Bone ◽  
Intravenous Calcium

Abstract Objectives. Hungry bone syndrome (HBS) is a severe and underdiagnosed complication of parathyroidectomy in the treatment of primary hyperparathyroidism (PHP) and secondary hyper-parathyroidism to chronic kidney disease (SHP-CKD). Methods. A longitudinal study was conducted to compare the postoperative outcomes of patients who developed HBS in two different time frames: before and after implementing a protocol with an intensive electrolytic monitoring and an algorithm regarding electrolytic supplementation. Results. Overall, 77 parathyroidectomies were included. In PHP, a protocol implementation led to an increased admission of patients in the Intermediate Care Unit for intensive electrolytic monitoring (p<0.001) and an increased rate of oral calcium replacement during hospital stay (p=0.013) compared to pre-protocol era. In SHP-CKD, duration of intravenous calcium replacement was reduced (p=0.010). The prevalence of HBS (9.8% in PHP and 58.3% in SHP-CKD) was similar between the two periods, although its diagnosis had an increased trend in PHP since the protocol implementation. None of the diagnosis of HBS was established due to hypocalcemic symptoms in the post-protocol era (contrary to pre-protocol period, p=0.021). Both hypocalcemia length and duration of surgical ward hospitalization were reduced (p=0.047 and p=0.042, respectively). Conclusions. An improved assessment of hyperparathyroidism and a decrease in HBS severity were noted in the post-protocol era. We strongly recommend the implementation of a standardized protocol with an intensive phosphocalcium monitoring in the high-risk patients who undergo parathyroidectomy due to hyperparathyroidism as it improves the health care and management of HBS.

scholarly journals Hypocalcemia-based prediction of hungry bone syndrome after parathyroidectomy in hemodialysis patients with refractory secondary hyperparathyroidism

2018 ◽  
Vol 46 (12) ◽  
pp. 4985-4994 ◽  
Author(s):  
Guang Yang ◽  
Xiaoming Zha ◽  
Huijuan Mao ◽  
Xiangbao Yu ◽  
Ningning Wang ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Calcium Supplementation ◽  
Hemodialysis Patients ◽  
Calcium Supplement ◽  
Total Parathyroidectomy ◽  
Prediction Equations ◽  
Hungry Bone Syndrome ◽  
Preoperative Serum ◽  
Hungry Bone ◽  
Intravenous Calcium

Objective This study was performed to explore the risk factors for hungry bone syndrome (HBS) and establish prediction equations for calcium supplementation after parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism. Methods We retrospectively analyzed data from 252 hemodialysis patients undergoing successful total parathyroidectomy with autotransplantation. HBS was defined according to a minimum postoperative serum corrected calcium (PcCa) concentration of <2.0 mmol/L. Independent predictors of HBS were analyzed, and prediction equations for HBS were derived accordingly. Results The incidence of HBS was 71.4%. The serum corrected calcium and preoperative serum alkaline phosphatase (ALP) concentrations were independent predictors of HBS. The preoperative serum ALP, intact parathyroid hormone (iPTH), and hemoglobin concentrations were independent factors influencing the average descending velocity of the PcCa concentration before calcium supplementation (PcCa-V), intravenous calcium supplement holding time (IVCa-T), and intravenous calcium supplement dosage (IVCa), while the serum ALP and iPTH concentrations were independent predictors of the oral calcium supplement dosage (OCa). Four prediction equations for PcCa-V, IVCa-T, IVCa, and OCa were established. Conclusions Establishment of prediction equations for HBS may contribute to a new individualized therapy for patients with HBS.

scholarly journals Parathyroid carcinoma and hungry bone syndrome

2013 ◽  
Vol 57 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Monique Nakayama Ohe ◽  
Rodrigo Oliveira Santos ◽  
Flavio Hojaij ◽  
Murilo Catafesta Neves ◽  
Ilda Sizue Kunii ◽  
...  
Keyword(s):  
Bone Disease ◽  
Parathyroid Carcinoma ◽  
Parathyroid Tissue ◽  
Neck Mass ◽  
The Other ◽  
Surgical Removal ◽  
Hungry Bone Syndrome ◽  
High Calcium ◽  
Hungry Bone ◽  
Intravenous Calcium

We hereby report two patients with parathyroid carcinoma presenting extremely high calcium and PTH levels, severe bone disease, and palpable neck mass at diagnosis. They both underwent parathyroidectomy, and one of them evolved to lung metastasis. Important hypocalcemia was observed after surgery in both: after parathyroidectomy in one patient, and only after surgical removal of the metastasis in the other. Both required intravenous calcium replacement, thus revealing hungry bone syndrome (HBS). HBS usually reflects rapid mineralization after correction of hyperparathyroidism. The more severe the bone disease before surgery, the more prone the patient is to HBS after surgery. Despite being an unfavorable outcome, HBS state suggests that surgical removal of hypersecretory parathyroid tissue was accomplished. In this study, HBS was observed in both patients, who presented severe bone disease prior to surgery. HBS would be expected post-operatively in successful parathyroid carcinoma removal.

Successful Treatment of Postparathyroidectomy Hypocalcemia Using Continuous Ambulatory Intraperitoneal Calcium (CAIC) Therapy

1989 ◽  
Vol 9 (4) ◽  
pp. 285-288 ◽  
Author(s):  
Robert L. Benz ◽  
Charles R. Schleifer ◽  
Brendan P. Teehan ◽  
Miles H. Sigler ◽  
Gary S. Gilgore
Keyword(s):  
Renal Disease ◽  
Effective Treatment ◽  
Calcium Gluconate ◽  
Calcium Uptake ◽  
Outpatient Basis ◽  
Total Calcium ◽  
Endstage Renal Disease ◽  
Hungry Bone Syndrome ◽  
Hungry Bone ◽  
Intravenous Calcium

Severe, recalcitrant hypocalcemia and hungry bone syndrome can complicate parathyroidectomy in endstage renal disease patients. Treatment with prolonged and massive doses of intravenous calcium, with calcitriol supplementation, is often necessary, but potentially dangerous and may prolong hospitalization. Three CAPD patients (including 1 with malabsorption) were safely treated by adding 1 to 3 ampules (10–30 mL) of 10% calcium gluconate solution to each bag of dialysate for up to 29 months. Continuous ambulatory intraperitoneal calcium (CAIC) therapy was initiated postoperatively and continued on an outpatient basis until the patients’ hungry bone syndrome resolved and serum calcium normalized. Complications such as visible dialysate precipitation or an increased rate of peritonitis were not observed. Mean total calcium uptake was approximately 137 to 226 mg/exchange. We conclude that CAIC therapy is a safe, effective treatment both for CAPD patients with postparathyroidectomy hypocalcemia with hungry bone syndrome, as well as in patients with hypocalcemia secondary to malabsorption.

scholarly journals Audio-guided self-hypnosis for reduction of claustrophobia during MR imaging: results of an observational 2-group study

2021 ◽  
Author(s):  
Adriane E. Napp ◽  
Torsten Diekhoff ◽  
Olf Stoiber ◽  
Judith Enders ◽  
Gerd Diederichs ◽  
...  
Keyword(s):  
High Risk ◽  
Mr Imaging ◽  
Odds Ratio ◽  
Control Group ◽  
Waiting Room ◽  
High Risk Patients ◽  
Imaging Results ◽  
Before And After ◽  
Risk Patients ◽  
And Coping

Abstract Objectives To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging. Methods In this prospective observational 2-group study, 55 patients (69% female, mean age 53.6 ± 13.9) used self-hypnosis directly before imaging. Claustrophobia included premature termination, sedation, and coping actions. The claustrophobia questionnaire (CLQ) was completed before self-hypnosis and after MR imaging. Results were compared to a control cohort of 89 patients examined on the same open MR scanner using logistic regression for multivariate analysis. Furthermore, patients were asked about their preferences for future imaging. Results There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14; p = .001). Self-hypnosis patients also needed less sedation (2% vs 16%; 1/55 vs 14/89; odds ratio .1; p = .008) and non-sedation coping actions (13% vs 28%; 7/55 vs 25/89; odds ratio .3; p = .02). Self-hypnosis did not influence the CLQ results measured before and after MR imaging (p = .79). Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49; p = .002). In the subgroup below the CLQ cut-off of 0.33, there were no significant differences (0% vs 9%, 0/6 vs 1/11; p = 1.0). Most patients (67%; 35/52) preferred self-hypnosis for future MR examinations. Conclusions Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions. Key Points • Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner. • Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia. • Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations.

Hypocalcémie sévère et prolongée en post-transplantation rénale : « The Hungry Bone Syndrome » à ne pas méconnaître

2021 ◽  
Vol 17 (5) ◽  
pp. 396-397
Author(s):  
M. Hamdaoui ◽  
S. Mchiouer ◽  
I. Haouli ◽  
H. Oujidi ◽  
K. Frikel ◽  
...  
Keyword(s):  
Post Transplantation ◽  
Hungry Bone Syndrome ◽  
Transplantation Rénale ◽  
Hungry Bone

Implementation of a Standardized Perioperative Pain Management Protocol to Reduce Opioid Prescriptions in Otolaryngologic Surgery

2022 ◽  
pp. 019459982110711
Author(s):  
Michael T. Chang ◽  
M. Lauren Lalakea ◽  
Kimberly Shepard ◽  
Micah Saste ◽  
Amanda Munoz ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Lower Amount ◽  
Opioid Use ◽  
Protocol Implementation ◽  
Perioperative Pain ◽  
Management Protocol ◽  
Before And After ◽  
Perioperative Pain Management ◽  
Low Levels

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

scholarly journals "Hungry Bone" Syndrome after Parathyroidectomy: Up-To-Date

2015 ◽  
Vol 11 (04) ◽  
Author(s):  
Daniela Tatiana Sala ◽  
Ioan Tilea
Keyword(s):  
Hungry Bone Syndrome ◽  
Hungry Bone

scholarly journals Removing the problem: parathyroidectomy for calciphylaxis

2018 ◽  
Vol 11 (1) ◽  
pp. e226696 ◽  
Author(s):  
Mohamed Hassanein ◽  
Heather Laird-Fick ◽  
Richa Tikaria ◽  
Saleh Aldasouqi
Keyword(s):  
Treatment Options ◽  
Sodium Thiosulfate ◽  
Skin Lesions ◽  
Phosphate Binders ◽  
Treatment Resistant ◽  
Hungry Bone Syndrome ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hungry Bone

Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.

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