Leanne, Dori suggested I get your input on a serious issue I’m having regarding profound hypotension post-parathyroidectomy.
It’s rather a long story, so would you mind me just posting the links to the conversation as it already exists on Dr. Agar’s section? There are two threads: one stating the original problem and a more recent follow-up. Any thoughts you could provide would be invaluable and very much appreciated.
http://forums.homedialysis.org/threads/3368-Mysterious-hypotension
and
http://forums.homedialysis.org/threads/3397-Update-on-Mysterious-Hypotension
Thank you again in advance!
Hello and thank you for your message. I read through the threads in the links you provided. While blood pressure is not my area, I do have quite a bit of experience working with people with secondary hyperparathyroidism (high PTH) as well as parathyroidectomy and nocturnal hemodialysis modality. We do see many patients after parathyroidectomy surgery with hungry bone syndrome. In these cases the blood calcium level can get extremely low. The physicians I work with are very aggressive at treating the low calcium levels with IV calcitriol and oral calcium supplements right after surgery and ongoing. Increasing the calcium bath is most always part of the treatment. Sensipar, which may have been taken in the past, is discontinued. Calcium levels are usually checked more often for some time after the surgery - maybe weekly depending on the case. Also, I apologize if I missed it in your previous threads, but has your nephrologist checked an ionized calcium level (calcium not attached to proteins)? At our clinic ionized calcium is not part of the regular labs checked. This could provide more info on the whole picture of what is going on. I believe it is possible to have a normal or high serum calcium and a low ionized calcium, which could explain your concerns. I just want to touch on what you mentioned about your MD and RD being concerned over calcium levels greater than 10.2. I am sure you are aware of the potential issues related to elevated calcium and calcification. While you are dealing with a quality of life issue - your blood pressure - your team is most likely concerned about the potential long-term risks that come along with hypercalcemia. It sounds like you are doing a good job of working with your team, but also advocating for yourself. Please let us know what happens.
LeeAnn Weintraub, MPH, RD