Measure calcium on evening of operation, use corrected calcium value to follow the flow - PowerPoint Presentation

1. Measure calcium on evening of operation, use corrected calcium value to follow the flow chart belowPathway for monitoring calcium levels post thyroidectomyIf you start a patient on this pathway, please email the patient’s consultant to make them awareBelow 1.9 with tetany/seizures or below 1.7mmol/l20ml 10% calcium gluconate diluted in 100 – 200ml normal saline 0.9% given iv over 10 minutes – repeat if symptoms persistSet up calcium infusion – 100ml of 10% calcium gluconate added to 1 litre normal saline 0.9% over 24 hoursCommence calcichew 2 tablets tds and 1 alpha calcidol 1 mcg per day (if already on this continue this treatment)See below for ongoing management (4)Below 1.9 mmol/l and above 1.7mmol/l and mild symptoms (paraesthesia only) Commence calcichew 2 tablets tds and 1 alpha calcidol 1 mcg per dayRecheck next morningBetween 1.9 and 2.1 mmol/lCommence calcichew 2 tablets tdsAbove 2.1mmol/lObserve and recheck next morningAbove 2.1mmol/l?DischargeManage as per boxes 1, 2 or 3 aboveRecheck next morningStable or rising and above 1.9mmol/l?Discharge with calcium supplementation. Recheck calcium before clinic appointment at one weekyesyesnonoAssess symptoms and calcium levelSevere symptoms (tetany and/or seizures) or calcium <1.7mmol/l?Mild or no symptoms and Ca above 1.7mmol/l?Add 1 alpha calcidol 1mcg per day and recheck at 24 hours (if already on 1 alpha simply recheck at 24 hoursAbove 1.9mmol/l?Below 1.9mmol/l?Discuss with endocrine teamIf at any time the patient develops tetany and/or seizures thought to be related to calcium, flowchart 3 should be followed Patient on 24 hour calcium infusion (100ml of 10% calcium gluconate added to 1 litre saline over 24 hours)Make sure patient written up for calcichew 2 tablets tds and 1 alpha calcidol 1 mcg odCheck calcium every 6 hoursCalcium above 2?Continue current infusion rateHalve infusion rateaCalcium below 2 after 6 hoursIncrease rate to original rateCalcium remains above 2 after 6 hoursStop infusionRecheck at 6 hoursBelow 2mmol/l – recommence infusion at half rate and continue to check 6 hourly and follow protocol from aAbove 2mmol/l – recheck at 12 and 24 hoursSymptoms of hypocalemia to look out for:ConfusionMuscle spasmsNumbness and tingling in peripheriesMuscle crampsAll requiring a calcium infusion must be referred to endocrinologyOnce off infusion can be discharged if Ca remains above 2mmol/l for 24 hours – must be seen with repeat calcium in clinic within 1 weekyesno