title: Management of calcium refilling post-parathyroidectomy in end-stage renal disease.
abstract: BACKGROUND
  Management of post-parathyroidectomy hypocalcemia in dialysis patients is not well defined. We reviewed published approaches to treatment in an effort to define a clinical algorithm for controlling serum calcium levels post-operatively.
  
  
  METHODS
  We conducted a PubMed search for the years 1980-2003 with the keywords "hypocalcemia" and "parathyroidectomy". Only English language and human subject abstracts were analyzed, and only those articles dealing with secondary or tertiary hyperparathyroidism (HPTH) were reviewed further. Other articles were extracted from cross-referencing.
  
  
  RESULTS
  We initially examined 146 articles. This review summarizes the findings of the relevant articles along with our own practice regarding post-parathyroidectomy hypocalcemia management in dialysis patients. The vast majority of patients require intravenous (i.v.) calcium supplements after surgery. There are no available controlled studies on calcium supplementation for post-parathyroidectomy hypocalcemia in this patient population. Calcitriol supplementation proved valuable in two studies.
  
  
  CONCLUSIONS
  Post-parathyroidectomy hypocalcemia is a common complication, which can be prevented and treated with oral and i.v. calcium supplementation and/or active vitamin D metabolites. Daily follow-up of both serum calcium and phosphorus are mandatory to prevent this major post-operative complication. Based on the available evidence, we propose a protocol for the prevention and treatment of post-parathyroidectomy hypocalcemia, for use in clinical practice. This approach requires validation by a controlled clinical trial.
authors.affiliation: Renal Unit, San Paolo Hospital, University of Milan, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Carlo
authors.initials: C
authors.lastname: Corsi
authors.forename: Amelia
authors.initials: A
authors.lastname: Bastagli
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
mesh_terms: D000284:Administration, Oral; D002117:Calcitriol / Q000008:administration & dosage; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery; D006996:Hypocalcemia / Q000209:etiology / Q000628:therapy*; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000150:complications*; D008274:Magnesium / Q000008:administration & dosage; D016105:Parathyroidectomy / Q000009:adverse effects*; D010710:Phosphates / Q000008:administration & dosage; D006435:Renal Dialysis
chemical_list: D010710:Phosphates; D002117:Calcitriol; D008274:Magnesium; D002118:Calcium