Desired PTH, hypophosphatemia, hypercalcemia

Patient Scenario: Desired PTH, hypophosphatemia & hypercalcemiadoc_thinking

 

Assessing the Clinical and Laboratory Parameters

This is an unusual combination, possibilities include;

  • Excess use of calcium binders
  • Malnutrition and/or immobilization

Less than 1% of all patients are in this category.

 

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Dialysis Prescription

A decrease in dialysate calcium by 0.25-0.5 mmol/L (0.50-1.0 mEq/L) may alleviate hypercalcemia.

 

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Phosphate and Calcium Management

The use and quantity of calcium binders needs to be reduced to provide normocalcemia and normal phosphate.  Adequate nutrition may be a factor and should be addressed.

 

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PTH Management

Vitamin D sterols

PTH may rise when correcting hypercalcemia and hypophosphatemia are corrected.  An active vitamin D sterol could be introduced or a calcimimetic should be considered if hyperphosphatemia and/or hypercalcemia persist.

Calcimimetics

Other Options of Controversies in Management

This combination may also be seen in dialysis treatments such as frequent nocturnal hemodialysis or short daily hemodialysis with a normal or high dialysate calcium.  Addition of phosphate to the dialysate may be indicated in this situation.


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Other Options of Controversies in Management

This combination may also be seen in dialysis treatments such as frequent nocturnal hemodialysis or short daily hemodialysis with a normal or high dialysate calcium. Addition of phosphate to the dialysate may be indicated in this situation.

 

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