A 46-year-old man undergoes a parathyroidectomy given recurrent episodes of dehydration and kidney stones caused by hypercalcemia secondary to an elevated PTH level. He is recovering on the surgical floor on day 3. His temperature is 97.6°F (36.4°C), and his blood pressure, pulse, respirations, and oxygen levels are normal. The patient is complaining of bone tenderness and pain. What is the most appropriate management of this patient? 

calcium

potassium

TSH

Vitamin D

Calcium

Step-by-step explanation

Observation is indicated in asymptomatic hypocalcemia.

• Potassium phosphate is used to treat hypophosphatemia which can present with U waves on ECG and muscle weakness/cramping. 
• TSH level would be indicated if this patient had suspected hypothyroidism which would present with fatigue, lethargy, weight gain, hyponatremia, and sinus bradycardia.  
• Vitamin D supplementation would not acutely resolve this patient's symptoms and hypocalcemia. This patient will likely need lifelong vitamin D supplementation given his lack of PTH

Postoperative hypocalcemia is common following successful parathyroidectomy. The initial treatment of asymptomatic hypocalcemia is oral calcium such as calcium.