Running Head : HYPOPARATHROIDISM 1 Hypoparathyroidism : Hyperphosphatemia and Treatment

Treatments for hyperphosphatemia in hypoparathyroidism were identified as a low-phosphorus diet, phosphate binders, diuretics, and parathyroid hormone replacement (PTH 1-34 and PTH 184). The treatments that have proven considerable promise for the hypoparathyroid patient were the parathyroid hormone replacement therapies. The author recommended PTH 1-84 as the mainstay of hormone replacement therapy as it had already been granted FDA orphan drug status. The author also recommended more research on the effectiveness of the low-phosphorus diet and phosphate binders on lowering phosphate levels in hypoparathyroidism. Although there was sufficient literature and studies involving hyperphosphatemia in ESRD, little research has been reported in the treatment for hypoparathyroidism. The purpose of this study was to identify the treatments and their effectiveness for hyperphosphatemia in hypoparathyroidism. There was a definite gap in the knowledge needed for evidence-based practice of hyperphosphatemia in hypoparathyroidism. Using Josephine and Loretta Zderad’s humanistic theory, the author concluded that nurses have the opportunity to support hypoparathyroid patients by educating, assisting, and providing more evidence-based practice. HYPOPARATHYROIDISM 3 Hypoparathyroidism: Hyperphosphatemia and Treatment Hypoparathyroidism is a rare disorder affecting 65,000 people in the United States, and 120,000 people outside of the United States (Public Radio (PR) Newswire, 2010). The most common cause of hypoparathyroidism is inadequate secretion of parathyroid hormone after interruption of blood supply to the parathyroids or surgical removal during thyroidectomy, parathyroidectomy, or radical neck dissection (Smeltzer, Bare, Hinkle, & Cheever, 2008, p. 1472). In the case where the parathyroids are accidentally removed, without hormone replacement therapy or treatment, a rapid decline in blood calcium level leads to fatal tetany within 3 or 4 days (Saladin, 2007, p. 668). But with others, it is caused by a rare genetic disorder or an autoimmune disorder as with my son. Our experience with hypoparathyroidism has put us in the hospital many times, at the Annual Hypoparathyroidism Patient Conference in Washington D.C., and experimentally treating his hypercalcuria and hyperphosphatemia with injectable parathyroid hormone (PTH) 1-34, otherwise known as Forteo, at the Mayo Clinic. Of all our experiences of being “chained to a pill box” or middle of the night blood draws or trips to the ER, the diet prescribed to my son has been the most difficult, leaving my son staring at his food and anorexic. The “no-phosphorus diet,” as our endocrinologist described it, is one way to treat hyperphosphatemia. This low-phosphorus diet, among other therapies, is used to treat hyperphosphatemia, and is the focus of this research report. More research is needed on this disease and its treatments. The significance of this literature review is to generate knowledge on hypoparathyroidism and hyperphosphatemia for nursing practice.