Three days after parathyroidectomy for a large parathyroid adenoma (preoperative calcium 13.2 mg/dL), a patient develops perioral tingling, carpopedal spasm, and a positive Chvostek sign. Calcium is 6.4 mg/dL, phosphate 1.4 mg/dL, and magnesium 1.9 mg/dL. Which is the most appropriate treatment?
- A Intravenous calcium gluconate infusion plus oral calcitriol ✓
- B Oral calcium carbonate alone with dietary phosphate restriction
- C Intravenous pamidronate to suppress further bone resorption
- D Teriparatide injection to mobilise skeletal calcium
Correct answer: A. Intravenous calcium gluconate infusion plus oral calcitriol
Explanation
This is hungry bone syndrome: chronically stimulated osteoblasts avidly take up calcium and phosphate after the PTH source is removed, causing profound symptomatic hypocalcaemia with hypophosphataemia. Acute symptoms require intravenous calcium gluconate, and calcitriol is needed because PTH-dependent renal activation of vitamin D is absent. Pamidronate would worsen hypocalcaemia, and oral calcium alone cannot correct acute tetany.
Reference: Williams Textbook of Endocrinology, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.