HBS

 Q: 54 years old male with End-Stage Renal Disease (ESRD) is postoperative parathyroidectomy. The patient is transferred from the floor to ICU on a postoperative day #3 due to clinical symptoms of "Hungry Bone Syndrome" (HBS). All of the following are the feature of HBS EXCEPT?

A) hypocalcemia 

B) hypophosphatemia 

C) hypomagnesemia 

D) hypokalemia

Answer: D

Hypocalcemia immediately after parathyroidectomy is almost always universal. Usually, it is transient but ESRD patients have a high tendency to go into hypocalcemia crisis and it may last longer. 

In hyperparathyroidism, parathyroid hormone (PTH) increases bone formation and resorption with a net efflux of calcium from bone, resulting in hypercalcemia. The acute withdrawal of the parathyroid hormone (PTH) results in an imbalance resulting in a marked bone uptake of calcium, phosphate, and magnesium. The overall indirect effect on electrolytes is hyperkalemia, particularly in renal patients.

#electrolytes

#endocrinology

#surgical-critical-care

References:

1. Cruz DN, Perazella MA. Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis 1997; 29:759. 

2. Shpitz B, Korzets Z, Dinbar A, et al. Immediate postoperative management of parathyroidectomized hemodialysis patients. Dial Transplant 1986; 15:507.