Life-Threatening Hypocalcemia following Subtotal Parathyroidectomy in a Patient with Renal Failure and Previous Roux-en-Y Gastric Bypass Surgery | Zendy

Betsy Palal | Zendy; Marvin Sinsakul | Zendy; Sirimon Reutrakul | Zendy

Open Access

Life-Threatening Hypocalcemia following Subtotal Parathyroidectomy in a Patient with Renal Failure and Previous Roux-en-Y Gastric Bypass Surgery

Author(s) -

Betsy Palal,

Marvin Sinsakul,

Sirimon Reutrakul

Publication year - 2011

Publication title -

case reports in endocrinology

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 0.26

H-Index - 6

eISSN - 2090-6501

pISSN - 2090-651X

DOI - 10.1155/2011/370583

Subject(s) - medicine , calcitriol , surgery , hypoparathyroidism , calciphylaxis , hemodialysis , gastric bypass surgery , parathyroidectomy , secondary hyperparathyroidism , parathyroid gland , hyperparathyroidism , vitamin d and neurology , malabsorption , calcium , parathyroid hormone , gastroenterology , gastric bypass , disease , weight loss , obesity

Background. Roux-en-Y gastric bypass (RYGB) can result in calcium and vitamin D deficiency. Parathyroid surgery carries the risk of immediate and long-term hypocalcemia. Methods and Results. We describe a 54-year-old woman with history of end-stage renal disease and gastric bypass surgery who developed calciphylaxis requiring a 3.5-gland parathyroidectomy. Seven weeks later, she presented with weakness, perioral numbness, leg cramps, a positive Chvostek's sign, hypotension, prolonged QT-interval, and serum calcium of 5.4 mg/dL. Oral and intravenous calcium, calcitriol, and high calcium bath hemodialysis were given. She required 18 days of intravenous calcium and an outpatient maintenance regimen of calcitriol 6 mcg/day, calcium carbonate 8 grams/day, calcium citrate 1.2 grams/day, and ergocalciferol 50,000 IU/week. Conclusion. The patient's life-threatening prolonged hypocalcemia and large requirements of calcium and calcitriol were due to a combination of malabsorption, hypoparathyroidism, and renal failure. Special considerations should be given to bariatric surgery patients undergoing neck exploration.

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