SAT-744 Difficulties In The Inpatient Management Of Hungry Bone Syndrome Following Parathyroidectomy In A Peritoneal Dialysis Patient

Abstract Disclosure: P. Nepali: None. H.B. Ghimire: None. S. Bogati: None. G. Masnata: None. S. Rahman: None. S. Governor: None. M. Khan: None. N. Redmann: None. Introduction: HungryBone Syndrome (HBS) is a state characterized by prolonged hypocalcemia below 8.4 mg/dL for over 4 days following parathyroidectomy, particularly severe in end-stage renal disease (ESRD). Removing excess parathyroid hormone (PTH) triggers increased osteoblastic activity, causing rapid calcium consumption by the bones. In ESRD patients, pre-existing high bone turnover and osteoclastic activity may exacerbate this response. Case presentation: 56-year-old male with ESRD on peritoneal dialysis, hypertension, and secondary hyperparathyroidism underwent total parathyroidectomy with autotransplantation in another facility. Presurgery labs significant for PTH level 1,747 pg/ml, intact PTH 7049 pg/ ml, calcium 10.8 mg/dl, phosphorus 10.2 mg/dl and vitamin D 20.7 ng/ml. He was discharged on calcitriol 0.5 mcg daily and cholecalciferol, but was non-adherent with the treatment. Twelve days later post surgery, he presented with symptoms of tingling sensation in both hands and lower extremities with generalized weakness, somnolence, and blurred vision. At admission, blood pressure was 91/61 mmHg. Patient had muscle spasms, hypertonia, and lower limb tenderness. Labs showed severe hypocalcemia (Ca 3.3 mg/dL, ionized Ca 1.0 mg/dL), phosphorus 13.0 mg/dL, intact PTH 8.4 pg/mL, and EKG reported corrected QT interval 542 ms. He was initially admitted to the ICU, then transferred to the medical unit. Patient was given IV calcium gluconate, and started on calcium acetate and cholecalciferol. Patient underwent emergency hemodialysis. He was initially started on low dose calcitriol, which was gradually increased. Despite therapy, calcium remained low (5.5-5.7 mg/dL) for 16 days. Increasing calcium acetate to 2,668 mg TID had minimal effect. Calcitriol was escalated to 2 mcg BID, leading to significant improvement (Ca 7.0-8.7 mg/dL). The patient was getting high calcium bath hemodialysis thrice weekly. After a 28-day hospital stay, his calcium level was 10.2, and he was discharged on calcitriol, cholecalciferol, and calcium supplements. Conclusion: HBS is a rare complication after post-parathyroidectomy and requires aggressive calcium and calcitriol therapy. This case emphasizes early high-dose calcitriol in ESRD patients to prevent prolonged hospitalization and the importance of preventive measures, close monitoring, and patient education to mitigate the risk of this complication. Presentation: Saturday, July 12, 2025