Skip to main content

Skin Necrosis After Intravenous Calcium Chloride Administration as a Complication of Parathyroidectomy for Secondary Hyperparathyroidism: Report of Four Cases

Abstract

Intravenous (i.v.) calcium chloride is usually given to treat symptomatic hypocalcemia; however, the extravasation of calcium solution may cause soft tissue and skin necrosis. After parathyroidectomy and autotransplantation for secondary hyperparathyroidism associated with end-stage renal failure, i.v. calcium infusion is often necessary to treat severe postoperative hypocalcemia. We reviewed 371 patients who underwent parathyroidectomy for secondary hyperparathyroidism between January 2000 and June 2005, 96 of whom received i.v. calcium postoperatively for symptomatic hypocalcemia. We report the cases of three (3%) of our own patients and of one patient referred to our hospital, who suffered skin necrosis after i.v. calcium solution administration. These reports show that i.v. calcium should be administered into large veins, or via a central line, and diluted in an appropriate volume of solution. Moreover, the calcium solution infusion should be ceased if the patient complains of tenderness over the injection site. If skin necrosis develops, we suggest early debridement and a simple split thickness skin graft to repair the skin defect. We report our experience to remind surgeons of the danger of calcium chloride injection and to discuss ways of preventing and treating this complication.

This is a preview of subscription content, access via your institution.

References

  1. FF Chou CH Lee JB Chen SC Huang CT Lee (2005) ArticleTitleSleep disturbances before and after parathyroidectomy for secondary hyperparathyroidism Surgery 137 IssueID4 426–30 Occurrence Handle15800490 Occurrence Handle10.1016/j.surg.2004.12.010

    PubMed  Article  Google Scholar 

  2. GW Randolph (2003) Surgical management of multiglandular parathyroid disease GW Randolph (Eds) Surgery of the thyroid and parathyroid glands Saunders Philadelphia

    Google Scholar 

  3. A Jucgla G Sais N Curco J Marcoval A Moreno J Peyri (1995) ArticleTitleCalcinosis cutis following liver transplantation: a complication of intravenous calcium administration Br J Dermatol 132 IssueID2 275–8 Occurrence Handle7888367 Occurrence Handle1:STN:280:DyaK2M7psVyrsA%3D%3D Occurrence Handle10.1111/j.1365-2133.1995.tb05026.x

    PubMed  CAS  Article  Google Scholar 

  4. P Yosowitz DA Ekland RC Shaw RW Parsons (1975) ArticleTitlePeripheral intravenous infiltration necrosis Ann Surg 182 IssueID5 553–6 Occurrence Handle811181 Occurrence Handle10.1097/00000658-197511000-00003 Occurrence Handle1:STN:280:DyaE28%2FmtVGktg%3D%3D

    PubMed  Article  CAS  Google Scholar 

  5. WR Saeed S Distante JD Holmes PS Kolhe (1997) ArticleTitleSkin injuries afflicting three oil workers following contact with calcium bromide and/or calcium chloride Burn 23 IssueID7–8 634–7 Occurrence Handle10.1016/S0305-4179(97)00040-5 Occurrence Handle1:STN:280:DyaK1c3ivFOlsw%3D%3D

    Article  CAS  Google Scholar 

  6. HS Zackheim H Pinkus (1957) ArticleTitleCalcium chloride necrosis of the skin; report of two cases AMA Arch Dermatol 76 IssueID2 244–6 Occurrence Handle1:STN:280:DyaG2s%2FptVarsQ%3D%3D

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lin, CY., Hsieh, KC., Yeh, MC. et al. Skin Necrosis After Intravenous Calcium Chloride Administration as a Complication of Parathyroidectomy for Secondary Hyperparathyroidism: Report of Four Cases. Surg Today 37, 778–781 (2007). https://doi.org/10.1007/s00595-006-3426-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-006-3426-z

Key words

  • Calcium chloride
  • Parathyroidectomy
  • Skin necrosis