Hungry Bone Syndrome — FRCA Final MCQ

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HardGeneral AnaesthesiaHungry Bone SyndromeFRCA Final

A 72-year-old man (ASA IV) with end-stage renal failure is undergoing a parathyroidectomy. His pre-operative calcium is 3.4 mmol/L (corrected). Post-operatively his calcium drops to 1.5 mmol/L. He develops tetany and QTc prolongation. This precipitous drop is known as:

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Correct answer: C — Pseudohypoparathyroidism

Hungry bone syndrome occurs after parathyroidectomy in patients with longstanding hyperparathyroidism and significant bone disease. The sudden reduction in PTH after gland removal causes rapid uptake of calcium, phosphate, and magnesium into 'hungry' demineralised bone, causing severe and prolonged hypocalcaemia. Risk factors include: high pre-operative calcium, large adenoma, renal osteodystrophy, and high pre-operative ALP (indicating active bone turnover). Management: aggressive IV calcium replacement (calcium gluconate infusion), oral calcium and alfacalcidol, and monitoring for 5-7 days. It can be life-threatening.

Reference: RCOA – 2023 – Endocrine anaesthesia; BAETS – 2023 – Parathyroid surgery guidelines