Hypoparathyroidism medical therapy: Difference between revisions

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*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
===Hypoparathyroidism===


* '''1 Stage 1 - Name of stage'''
* '''1 Management of Acute hypocalcemia'''
** 1.1 '''Specific Organ system involved 1'''
*:'''Note:''' IV calcium used for marked hypocalcemia (<7.0 mg/dL), hypocalcemia associated with symptoms, and if patients unable to take or absorb oral supplements.
*** 1.1.1 '''Adult'''
** 1.1 '''Intravenous calcium supplementation'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**:* Preferred regimen (1): Calcium gluconate 1 to 2 g in 50 mL of 5% dextrose over 10-20 minutes initially followed by maintenance by 50 – 100 mg/hour.
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**:: '''Note:''' Rapid infusion of calcium gluconate should not be used as it carries serious risk of cardiac dysfunction, including systolic arrest.
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
** 1.2 '''Parenteral vitamin D therapy'''
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**:* Preferred regimen (1): Calcitriol 0.25 to 0.5 μg q12h
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
** 1.3 '''Intravenous Magnesium supplementation (in case of hypomagnesia)'''
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
**:* Preferred regimen (1): Magnesium sulfate 2g (16mEq) as 10% solution, infused over 10 -20 minutes initially, followed by 1g (8 mEq) in 100 mL infused over an hour.
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 2.1 '''Specific Organ system involved 2'''
*** 2.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 2.1.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
* 2 '''Conventional therapy for hypoparathyroidism'''
** 2.1 '''Specific Organ system involved 1 '''
** 2.1 '''Oral calcium'''
**: '''Note (1):'''  
**:* Preferred regimen (1): Calcium carbonate (40% elemental calcium) '''(better absorption with meals) '''
**: '''Note (2)''':
**:* Alternative regimen (1): Calcium citrate (21% elemental calcium) '''(more effective in patients with achlorhydria and PPI use, worsening constipation)'''
**: '''Note (3):'''  
** 2.2 '''Vitamin D supplementation'''
*** 2.1.1 '''Adult'''
**:* Preferred regimen (1): Calcitriol 0.25 to 2 μg q24h (>.75 μg administered in divided doses)
**** Parenteral regimen
**:* Preferred regimen (2): Cholecalciferol (parent vitamin D3)
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
**:* Preferred regimen (3): Ergocalciferol (parent vitamin D2)
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
**:* Alternative regimen (1): 1α-Hydroxyvitamin D (alfacalcidol) '''(used outside the United States)'''
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**:* Alternative regimen (2): Dihydrotachysterol '''(used outside the United States)'''
**** Oral regimen
**:: '''Note(1):''' Serum calcium (corrected for albumin), phosphorus, and creatinine concentrations should be measured weekly to monthly during dose adjustments, and twice annually once a stable regimen has been reached.  
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
**:: '''Note(2):'''Urinary calcium and creatinine should be considered during dose adjustments and should be measured twice annually on a stable regimen to evaluate for renal toxicity
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
* 3 '''Adjunctive Treatments'''
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
** 3.1 '''Diuretics'''
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*** 3.1.1 '''Thiazides'''
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
****Preferred regimen (1): Hydrochlorothiazide 25–50 mg q12h (minimum 25 mg to maximum 100 mg)
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
****Alternative regimen (1): Chlorthalidone
*** 2.1.2 '''Pediatric'''
***:Note: Thiazide diuretics are not advised in congenital hypoparathyroidism due to autoimmune polyendocrine syndrome type 1 in patients who have concurrent Addison's disease or in autosomal dominant hypocalcemia.
**** Parenteral regimen
*** 3.1.2 '''Potassium sparing diuretics'''
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
****Alternative regimen (1): Amiloride 2.5 to 5 mg q12h
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
** 3.2 '''Treatment of hyperphoshatemia'''
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**:*Preferred regimen (1): Low phosphate diet
**** Oral regimen
**:*Preferred regimen (2): Phosphate binders
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
** 3.3 '''PTH replacement
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
**:*Preferred regimen (1): rhPTH 50 μg SC q24h '''(concomitantly decrease the dose of active vitamin D by 50%)'''
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
**::Monitor serum calcium and albumin concentrations every 3–7 days after initiation of therapy and after each dose change.
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''  
**: '''Note (2)''':
**: '''Note (3):'''  
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Revision as of 16:55, 22 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


Medical Therapy

Severe hypocalcemia, a potentially life-threatening condition, is treated as soon as possible with intravenous calcium (e.g. as calcium gluconate). Generally, a central venous catheter is recommended, as the calcium can irritate peripheral veins and cause phlebitis.

Long-term treatment of hypoparathyroidism is with calcium and Vitamin D3 supplementation (D1 is ineffective in the absence of renal conversion). Teriparatide, a synthetic form of PTH (presently registered for osteoporosis) might become the treatment of choice for PTH supplementation, although further studies are awaited.


Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
  • Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Hypoparathyroidism

  • 1 Management of Acute hypocalcemia
    Note: IV calcium used for marked hypocalcemia (<7.0 mg/dL), hypocalcemia associated with symptoms, and if patients unable to take or absorb oral supplements.
    • 1.1 Intravenous calcium supplementation
      • Preferred regimen (1): Calcium gluconate 1 to 2 g in 50 mL of 5% dextrose over 10-20 minutes initially followed by maintenance by 50 – 100 mg/hour.
      Note: Rapid infusion of calcium gluconate should not be used as it carries serious risk of cardiac dysfunction, including systolic arrest.
    • 1.2 Parenteral vitamin D therapy
      • Preferred regimen (1): Calcitriol 0.25 to 0.5 μg q12h
    • 1.3 Intravenous Magnesium supplementation (in case of hypomagnesia)
      • Preferred regimen (1): Magnesium sulfate 2g (16mEq) as 10% solution, infused over 10 -20 minutes initially, followed by 1g (8 mEq) in 100 mL infused over an hour.
  • 2 Conventional therapy for hypoparathyroidism
    • 2.1 Oral calcium
      • Preferred regimen (1): Calcium carbonate (40% elemental calcium) (better absorption with meals)
      • Alternative regimen (1): Calcium citrate (21% elemental calcium) (more effective in patients with achlorhydria and PPI use, worsening constipation)
    • 2.2 Vitamin D supplementation
      • Preferred regimen (1): Calcitriol 0.25 to 2 μg q24h (>.75 μg administered in divided doses)
      • Preferred regimen (2): Cholecalciferol (parent vitamin D3)
      • Preferred regimen (3): Ergocalciferol (parent vitamin D2)
      • Alternative regimen (1): 1α-Hydroxyvitamin D (alfacalcidol) (used outside the United States)
      • Alternative regimen (2): Dihydrotachysterol (used outside the United States)
      Note(1): Serum calcium (corrected for albumin), phosphorus, and creatinine concentrations should be measured weekly to monthly during dose adjustments, and twice annually once a stable regimen has been reached.
      Note(2):Urinary calcium and creatinine should be considered during dose adjustments and should be measured twice annually on a stable regimen to evaluate for renal toxicity
  • 3 Adjunctive Treatments
    • 3.1 Diuretics
      • 3.1.1 Thiazides
        • Preferred regimen (1): Hydrochlorothiazide 25–50 mg q12h (minimum 25 mg to maximum 100 mg)
        • Alternative regimen (1): Chlorthalidone
        Note: Thiazide diuretics are not advised in congenital hypoparathyroidism due to autoimmune polyendocrine syndrome type 1 in patients who have concurrent Addison's disease or in autosomal dominant hypocalcemia.
      • 3.1.2 Potassium sparing diuretics
        • Alternative regimen (1): Amiloride 2.5 to 5 mg q12h
    • 3.2 Treatment of hyperphoshatemia
      • Preferred regimen (1): Low phosphate diet
      • Preferred regimen (2): Phosphate binders
    • 3.3 PTH replacement
      • Preferred regimen (1): rhPTH 50 μg SC q24h (concomitantly decrease the dose of active vitamin D by 50%)
      Monitor serum calcium and albumin concentrations every 3–7 days after initiation of therapy and after each dose change.

References

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