Hyperparathyroidism

Hypercalcemia effects - High calcium causes weakness, arrhythmias, a shortened QT, dehydration from polyuria, and altered mentation; check the serum (ionized) calcium and correct significant hypercalcemia (hydration, sometimes more) before elective surgery.

Volume and renal protection - Hypercalcemia causes dehydration and can impair the kidneys; rehydrate and maintain urine output.

Positioning and bones - Bone disease raises fracture risk; position and pad carefully.

Post-parathyroidectomy hypocalcemia - After removal, calcium can fall (including 'hungry bone' syndrome); watch for hypocalcemia (tetany, laryngospasm, QT prolongation) and treat.

Neuromuscular blockers - The response can be unpredictable with calcium and muscle-weakness abnormalities; titrate with the twitch monitor.

Hyperparathyroidism is excess parathyroid hormone, usually from a parathyroid adenoma (primary), raising serum calcium by mobilizing it from bone, increasing gut absorption, and reducing renal excretion.

The result is hypercalcemia with its consequences — bones (osteopenia, fractures), stones (renal calculi and impaired renal function), abdominal and psychiatric symptoms — plus muscle weakness, arrhythmias, and a shortened QT. Curative treatment is parathyroidectomy; perioperatively the issues are the hypercalcemia and, after surgery, the swing toward hypocalcemia.