Review Question - QID 103032

This patient had his parathyroid gland removed and is now presenting with perioral numbness suggesting a diagnosis of hypocalcemia. Treatment with IV calcium gluconate is appropriate in symptomatic hypocalcemia.

Postoperative hypocalcemia is common following successful parathyroidectomy. The parathyroid gland normally detects low levels of calcium and releases PTH to increase serum calcium levels. After a parathyroidectomy, this method of homeostasis is lost and hypocalcemia is common. If hypocalcemia is asymptomatic, no treatment is necessary. Symptoms of hypocalcemia generally appear 2-4 days following surgery and include symptoms such as numbness (in particular, perioral numbness), paresthesias, and cramping (such as Chvostek and Trosseau signs). The initial treatment of symptomatic hypocalcemia is calcium gluconate. If symptoms are mild, oral calcium such as calcium lactate, calcium carbonate, or calcium gluconate can be given.

Incorrect Answers:
Answer 2: Observation is indicated in asymptomatic hypocalcemia. It would not be appropriate in this symptomatic patient after a parathyroidectomy.

Answer 3: Potassium phosphate is used to treat hypophosphatemia which can present with U waves on ECG and muscle weakness/cramping.

Answer 4: TSH level would be indicated if this patient had suspected hypothyroidism which would present with fatigue, lethargy, weight gain, hyponatremia, and sinus bradycardia.

Answer 5: Vitamin D supplementation would not acutely resolve this patient's symptoms and hypocalcemia. This patient will likely need lifelong vitamin D supplementation given his lack of PTH.

Bullet Summary:
Hypocalcemia is common after a parathyroidectomy and symptomatic patients should receive calcium gluconate.