Abstract: TH-PO0216
15 Years of Experience in Alkaline Phosphatase (ALP)-Based Calcium Replacement Protocol for Postparathyroidectomy Patients with ESKD
Session Information
- Bone and Mineral Metabolism: Clinical Reports and Practice
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Chong, Sin Yoong, Singapore General Hospital, Singapore, Singapore
- Chan, Choong Meng, Singapore General Hospital, Singapore, Singapore
- Choong, Lina, Singapore General Hospital, Singapore, Singapore
- Wong, Jiunn, Singapore General Hospital, Singapore, Singapore
Background
Despite routine calcimimetic use, parathyroidectomy (PTx) remains useful. Our prior ALP-based post-PTx calcium replacement protocol preemptively started intravenous (IV) and oral calcium (Ca) in immediate post-PTx patients based on their ALP levels. Ca infusion were run over 12 hours. This reduced incidences of hypocalcemia from hungry bone syndrome (HBS), but patients frequently experienced hypercalcemia from over replacement. Hence, the protocol was amended and audited.
Methods
After analyzing initial data from 195 patients (2008-2013), we halved the postoperative day IV Ca infusion time from 12 to 6 hours, maintaining the same Ca concentration. We then performed a clinical audit on patients who had PTx using anonymized patient data from the EMR (2020-2023).
Results
Total of 68 cases were identified. Median ALP on day of surgery was 312U/L (163-585). Mean cCa level was 2.41mmol/L±0.21 pre-op and 2.17mmol/L±0.21 post op. Mean cCA level from POD1 to POD7 were 2.29mmol/L±0.33, 2.31mmol/L±0.23, 2.44mmol/L±0.30, 2.47mmol/L±0.35, 2.51mmol/L±0.47, 2.46mmol/L±0.60 and 2.48mmol/L±0.80 respectively. Patients received a mean of 86mls±80 IV
10% Ca gluconate given immediately post surgery. Mean IV Ca given from POD1 to POD7 were 110mls±103, 103mls±82, 91mls±85, 78mls±68, 75mls±66, 75mls±59 and 75mls±57 respectively. We found that patients received 16% less IV Ca with the amended protocol. Mean oral elemental Ca post op from day of surgery to POD 7 were: 1.04g±0.26, 3.10g±0.78, 3.72g±1.2, 3.89g±1.53, 3.93g±1.67, 3.92g±1.60, 4.16g±1.64 and 3.82g±1.85 respectively. (Fig 1)
Conclusion
Post-amendment, total IV Ca received post-PTx and hypercalcemia risk were reduced, while not increasing rates of severe hypocalcemia from HBS. Regular clinical protocol audits are required to optimize patient care.
Fig 1