Immediate postoperative management of parathyroidectomized hemodialyzed patients

Parathyroidectomy is frequently necessary in the management of severe secondary hyperparathyroidism in dialyzed patients. No firm guidelines exist for the management of the immediate postoperative period. To standardize the treatment regimen, we reviewed the immediate postoperative course of 14 parathyroidectomized hemodialyzed patients. Postoperatively, in 11 out of 14 patients serum calcium levels (Ca) decreased within the first 24 hours. Of these, a more abrupt decline of Ca, occurring 8-16 hours postoperatively, was seen in seven patients. Hyperkalemia developed in 11 patients in the first 24 hours postoperatively. Patients whose rate of decline of Ca was more abrupt had significantly higher preoperative alkaline phosphatase levels (AP). Our regimen consisted of concurrent administration of intravenous Ca, oral vitamin D analogues, and calcium supplementation. Under this regimen, none of the patients experienced symptomatic hypocalcemia, and Ca levels stabilized at a mean of 8 mg/dl 48 hours postoperatively. The hyperkalemia was controlled conservatively in six patients, while the remaining five required dialysis. Hemodialysis during the immediate postoperative period may be complicated by bleeding into the operative wound with resultant airway compression. It should be delayed for at least the first 48 hours following operation. Should dialysis be indicated, usually because of hyperkalemia, peritoneal dialysis is the preferred mode.