甲状腺切除术后高钙血症1例

I. Katsarou, Ourania Drakoulongona, A. Christopoulos, Goula Konstantina
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引用次数: 1

摘要

1-3%的全甲状腺切除术患者并发甲状旁腺功能低下。甲状旁腺功能减退症的治疗是口服钙和维生素d补充剂。每天服用钙和维生素D有时会导致高钙血症。摄入大量钙和可吸收碱导致高钙血症、不同程度的肾功能衰竭和代谢性碱中毒,可与钙碱综合征的诊断相关。在20世纪初广泛采用牛奶和碱治疗消化性溃疡疾病后,该综合征首次被确定为乳碱综合征。随着组胺-2阻滞剂和质子泵抑制剂的引入,乳碱综合征的发生变得罕见;然而,由于碳酸钙的广泛使用和越来越多的使用,主要是为了预防骨质疏松症,最近出现了钙碱综合征。我们报告一位患有甲状旁腺功能减退症的女性患者,在接受碳酸钙、维生素D和噻嗪类利尿剂治疗后,出现了高钙血症和碱中毒。通过停用上述药物、静脉输液和增强肾钙排泄,患者治疗成功。表现为钙碱综合征的高钙血症是一种需要高度怀疑的诊断,以便快速识别疾病并开始适当的治疗。对于临床医生来说,将该综合征列入鉴别诊断清单是很重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Case of Hypercalcemia after Thyroidectomy
Abstract Total thyroidectomy is complicated by hypoparathyroidism in 1-3% of patients. Hypoparathyroidism is treated with oral calcium and vitamin-D supplements. Everyday use of calcium and vitamin D can lead sometimes to hypercalcemia. Ingestion of large amounts of calcium and absorbable alkali that cause hypercalcemia, various degrees of renal failure, and metabolic alkalosis, can be associated with a diagnosis of calcium-alkali syndrome. This syndrome was first identified as milkalkali syndrome, after treatment of peptic ulcer disease with milk and alkali which was widely adopted at the beginning of the 20th century. With the introduction of histamine-2 blockers and proton pump inhibitors, the occurrence of milk-alkali syndrome became rare; however, it has emerged recently as calcium-alkali syndrome because of the wide availability and increasing use of calcium carbonate, mostly for osteoporosis prevention. We present a female patient with hypoparathyroidism who presented with hypercalcemia and alkalosis as a result of treatment with calcium carbonate, vitamin D and thiazide diuretic. The patient was treated successfully by discontinuation of the above drugs, intravenous fluid administration and enhancement of calcium renal excretion. Hypercalcemia presenting as calcium-alkali syndrome is a diagnosis that requires a high index of suspicion in order to quickly identify the disorder and initiate appropriate therapy. It is important for clinicians to keep the syndrome on their list of differential diagnosis.
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