Parathyroid Disorders

First Things First (assess & treat for the following)

Hyperparathyroidism

• Does pt have severe hypercalcemia requiring immediate attention?
  • Corrected serum calcium >3.5 above upper limit of normal or ionized calcium level >20% above normal value and
    • Evidence of shock due to volume depletion
    • Mental status changes (psychosis, lethargy, stupor, coma)
    • EKG changes (short QT, arrhythmias)
    • Nausea, vomiting, and abdominal pain
    • Renal failure

Hypoparathyroidism

• Does pt have severe hypocalcemia requiring immediate attention?
  • Corrected serum calcium < 7.5 mg/dL or ionized calcium level < 80% of normal values and
    • Frank tetany, laryngospasm, perioral numbness and carpopedal spasms
      • Chvostek’s sign and Trousseau’s sign (which is more specific for hypocalcemia)
    • Arrhythmias: long QT, bradycardia, heart block, cardiac arrest
    • Hypotension, heart failure