A ROBINSON1, C CLARK1
1Capital And Coast District Health Board, Wellington, New Zealand
Background: Profound hypocalcaemia after parathyroidectomy is a potentially significant complication. We present a case successfully utilising intraperitoneal (IP) calcium replacement in a patient with severe hypocalcaemia post-parathyroidectomy and an intolerance of high dose oral preparations who was not receiving regular peritoneal dialysis (PD) but did have a Tenckhoff catheter in-situ.
Case Report: A 57-year old female underwent 3.5 gland parathyroidectomy for severe symptomatic tertiary hyperparathyroidism and secondary refractory anaemia on a background of reflux nephropathy. The patient was transplanted 12 years prior to parathyroidectomy. Two years prior, a Tenckhoff catheter was inserted in preparation for dialysis in the context of declining transplant graft function. The patient received training in PD but never commenced treatment due to stabilising chronic kidney disease. Pre-operative parathyroid hormone was 229.9 pmol/L. Within the first month post-parathyroidectomy, she was admitted to hospital on three occasions with profound symptomatic hypocalcaemia as low as an adjusted calcium of 0.89 mmol/L, despite best compliance with an onerous regime of oral replacement up to 28 micrograms of calcitriol and 11.25 grams of calcium carbonate a day. After her third admission, a decision was made to trial IP replacement of calcium using 30ml calcium gluconate 10% in a nightly dialysate dwell, without otherwise commencing regular dialysis. This allowed for maintenance of calcium levels within the normal range, with a significant reduction in oral replacement and the prevention of further hospitalisation. IP calcium replacement continued at a reducing frequency up until 10 weeks post-parathyroidectomy.
Conclusions: This case demonstrates successful treatment of life threatening hypocalcaemia with intraperitoneal calcium replacement in a patient with a Tenckhoff catheter in-situ who was not receiving regular dialysis.
I am a third year renal advanced trainee currently working in Wellington Hospital, New Zealand. My clinical interests include peritoneal dialysis, renal medicine in the older adult and palliative care. Outside of medicine, I am a keen sewist and enthusiastic purchaser of fabric.