Desired PTH, hypophosphatemia, hypercalcemia
Patient Scenario: Desired PTH, hypophosphatemia & hypercalcemia
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.
Dialysis Prescription
Dialysis Prescription
A decrease in dialysate calcium by 0.25-0.5 mmol/L (0.50-1.0 mEq/L) may alleviate hypercalcemia.
Phosphate and Calcium Management
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.
PTH Management
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.
Other Options of Controversies in Management
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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