dr.khaled ghonaim

1. Khaled Ghonaim
Nephrology Resident
New Mansoura General Hospital

2.  A 42 yr old patient named Soaad Abo Elnagah
Khalil, from Al-sharqia, housewife, married ,no
offspring , no special habits of medical
importance .
Personal history

3. Complaint
 Generalized bone aches for one year .

4.  The condition started one year ago with gradual
onset , progressive course of generalized bone
aches
 Patient seeked medical advice and
investigations were done which diagnosed as (
hyperparathyroidism)
Present history

5.  Patient received calcium carbonate & Cinacalcet
60 mg /day for 2 monthes but no improvment .
 Phosphate binder as sevelamer , but no
response .
Present history

6. labs
PTHpo4cadate
21509.88.322/12/201
8
22507.88.85/8/2019

7. US of the neck revealed ;

8.  ESRD on regular hemodialysis 14 years ago .
Past history

9.  HB:9.9
 WBCS: 5.1
 PLATELETS:120
 INR: 1.4
 SERUM CA : 8.9
 SERUM PHOSPHORUS :7.3
 PTH : 2150
 SERUM ALBUMEN :4.3
 SERUM CREATININE: 9.1
 SERUM UREA: 99
 PH: 7.31 HCO3: 25.2 PCO2:50
 NA: 140 K:4.2
Vit D:28.6
Pre-operative Lab

10. Cardiac consultation:
Bp; 110/70
HR; 90 b/m
ECG;normal
 ENT consultation : normal freely mobile
vocal cords .
Consultations

11. Decision
Parathyroidectomy after failure of oral medical
treatment.