case history 70/f, known diabetic, hypertensive, anemic (hb7.6gms%), ihd, tmt positive, electrolyte...
TRANSCRIPT
![Page 1: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/1.jpg)
Case History
• 70/F , Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month
• Presented with Hypercalcemic crisis (Coma- 2 months back), Persistent nausea & Vomiting
• Evaluated
![Page 2: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/2.jpg)
![Page 3: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/3.jpg)
Very High Calcium & PTH
![Page 4: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/4.jpg)
Biochemistry
![Page 5: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/5.jpg)
Hypercalcemic crisis managed medically
![Page 6: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/6.jpg)
![Page 7: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/7.jpg)
Concordant USG & Sestamibi Findings
![Page 8: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/8.jpg)
Sestamibi Scan
![Page 9: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/9.jpg)
USG: Showed a Single Right adenoma
![Page 10: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/10.jpg)
![Page 11: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/11.jpg)
Anaesthetist view
![Page 12: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/12.jpg)
Cardiologist Opinion: Very High surgical risk for Cardiac events
Transfused 1 pint of Packed RBCS the day before Surgery
![Page 13: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/13.jpg)
Positioning
![Page 14: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/14.jpg)
Plane between straps and sternocleidomastoid(SCM) muscle right side
SCM Straps
![Page 15: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/15.jpg)
Parathyroid visulaisation
SCM
Parathyroid tumor
![Page 16: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/16.jpg)
Visulalisation of both Parathyroid tumors
Inferior
Superior
![Page 17: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/17.jpg)
Thyroid
Superior
Inferior
Double Parathyroid adenomas
![Page 18: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/18.jpg)
Thyroid
Tumor bed after removal of both Parathyroid tumors,Wound Closed without a drain
![Page 19: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/19.jpg)
Surgical Specimen
![Page 20: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/20.jpg)
Closer view of the Double adenomas
Superior: 3.2x2.7x1.1cmWeight 8.2 gms
Inferior: 4.2x 3.1x2.6cmWeight 14.6 gms
![Page 21: Case History 70/F, Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month Presented](https://reader036.vdocuments.site/reader036/viewer/2022062417/551b478b550346ae7a8b4d90/html5/thumbnails/21.jpg)
Post opSerum Calcium Serum PTH
Preop 20.1, 19.0 15.6, 15.2, 12.4, 11.4( after 3 doses of Bisphophonates)
3864.6 pg/ml
Post op 9.1 304 pg/ml (1 hour postop)
Postop Day 2 7.2
Postop Day 3 8.1 (with calcium & Vit D Supplements)- discharged
Patient did not develop symptomatic hypocalcemia, Voice normal, Wound healthy discharged with Oral Calcium & vitamin D supplements