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Hypoparathyroidism, hypophosphatemia and low or normal calcium

Patient Scenario: Hypoparathyroidism, hypophosphatemia and low or normal calcium



Assessing the Clinical and Laboratory Parameters

Long term hypophosphatemia may be associated with osteomalacia. Assess dietary intake, nutritional status and binder use.

Assess if prior parathyroidectomy, which can result in low PTH, especially if a total removal was done.  If so, this constellation of biochemical findings suggests an imbalance between the vitamin D sterol replacement and the calcium replacement.

If no prior parathyroidectomy, this patient has hypoparathyroidism in association with normal or low calcium. There should be a natural stimulation to enhanced PTH production here if the calcium is low.

Assess use of medications, especially calcimimetics. Over suppression of parathyroid glands with a calcimimetic agent is possible in this patient, and the presence of hypophosphatemia and a normal or low calcium increases the likeliehood that any calcimimetic being used is in excessive dose. 

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

Therapeutic Options:

Dialysis Prescription

Dialysis Prescription

Depending on the phosphrous level, additional PO4 may need to be added to the dialysate. Dialysate calcium bath should be individualized to correct serum calcium into the normal range. Increasing calcium bath may further suppress the PTH level.

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