Concluding hemodialysis side effects in patients with parathyroidectomy (PTX), the clinical manifestations of hypocalcemia and treatment measures.
Back in April 2001 to April 2010 in our hospital in 96 cases of parathyroidectomy regularity dialysis complicated by secondary hyperparathyroidism in patients, male 47 cases, 49 cases of women; average age of 48.5 ± 10.2 ( years); dialysis age of 115 on average 8 ± 48.7 (January). The primary disease: chronic glomerulonephritis and 68 cases, polycystic kidney disease in six cases of renal arteriosclerosis disease in three cases, three cases of chronic renal interstitial disease, systemic lupus erythematosus patients, for unknown reasons 15 cases. Most patients in the dialysis side effects of preoperative calcium concentration of 1.5mmol / L dialysate dialysis, active vitamin D standard treatment. Parathyroidectomy surgery before and after calcium supplementation program: week preoperative oral supplementation with elemental calcium 1.8 g / d and active vitamin D0.5μg / d, in order to prevent the emergence of postoperative hypocalcemia. The majority of surgical parathyroidectomy for parathyroid hysterectomy, followed by a sub-total resection. Patients continue taking 0.9 ~ 3.6 (g / d) of elemental calcium and active vitamin D1 ~ 3 (μg / d); at the same time place the center vein infusion catheter, the rate of elemental calcium 2mg / kg / h of intravenous calcium gluconate; dialysis, dialysate calcium concentration to 1.75 to 2.25 (mmol / L), 1 or 2 times total serum calcium (Ca), postoperative tested daily for a week; during intravenous 10% calcium gluconate 10ml immediately when Ca <1.8 mg / dl or convulsion. When Ca stable at normal levels can be detected 1 to 2 times a week Ca appropriate to reduce or stop the intravenous calcium. Such as Ca is greater than 2.8mmol / L to reduce or disable the oral preparation of calcium and active vitamin D postoperative dialysis side effects will appear at different times and different levels of Ca decreased. Light by the clinical symptoms of anxiety, irritability, tingling of lips or distal extremities; weight by dizziness, weakness, palpitations, wheezing, sweating, or even sweating, two cases of patients presented with diarrhea, two cases of patients with muscle twitching. There are five cases of patients presented with low blood pressure, blockage within a week after arteriovenous fistula. Clinical signs of lower blood pressure, faster heart rate. 96 cases of parathyroid resection, the majority of patients in the second postoperative day the Ca decline of individual patients in the postoperative one to two weeks, two cases of hypocalcemia in the month after the outpatient dialysis . The second postoperative day the Ca an average of 1.96 ± 0.27 (mmol / L), the lowest serum calcium 1.3 mmol / L, the average supplement of elemental calcium 2.82 ± 1.68 (g / d), and active vitamin D1.38 ± 0.66 (μg / d ,); the Ca week after an average of 2.15 ± 0.32 (mmol / L), supplementary elemental calcium 2.76 ± 1.52 (g / d), and active vitamin D1.30 ± 0.75 (μg / d). Most patients one week after disabled intravenous calcium, oral calcium carbonate and active vitamin D to maintain the stability of the Ca in, but there are two cases of patients after surgery in January, still require intravenous calcium.
Successful parathyroidectomy have a decline in Ca. After close observation of clinical signs and symptoms, timely monitoring of blood Ca, dialysis side effects of sufficient quantities of supplemental calcium and active vitamin D, can be avoided and rapid remission of the clinical manifestations occur. Usually after two days Ca began to decline, most require intravenous calcium, after a positive supplemental calcium and active vitamin D Ca is about back to normal in about a week after surgery.
