Term
| What are some pitfalls in evaluating a total serum calcium as a surrogate for Ionized calcium levels? |
|
Definition
Hypoalbumin overestimates a deficeiency
Acidosis overestimates a deficiency
Alkalosis underestimates a deficiency |
|
|
Term
| What are the actions of Parathyroid Hormone? |
|
Definition
Calcium Resorption from Bone and Kidney
Phosphorous Excretion
Vit D Hydroxylation to 1,25 |
|
|
Term
| What are the actions of Vitamin D |
|
Definition
Intestinal Ca absorption
Renal and Bone Calcium Resorption
Inhibits PTH production
|
|
|
Term
| Where is vitamin D hydroxylated in the body? |
|
Definition
| Liver first(25-OH), kidney second(1-OH) |
|
|
Term
| How would a patient with hypercalcemia present? |
|
Definition
Stones
Psychoic
Pancreatitis
Bone Pain
Muscle Weakness |
|
|
Term
| What are the major causes of hypercalcemia? |
|
Definition
Primary/Secondary Hyperparathyroid
Vit D intoxication/ Milk-Alkali Syndrome
Malignancy
Granulomatous Disease
Familial Hypocalcinuric Hypercalcemia |
|
|
Term
| What are the treatment options for primary hyperparathyroidism and what factors decide the treatment course |
|
Definition
Parathyroidectomy or
Monitor Ca, Creatinine, DXA scan yearly
Motives for surgery: Old, Renal Disease, Osteoporosis, Very high Ca |
|
|
Term
| What is the major mechanism of malignancy-induced hypercalcemia |
|
Definition
| Release of high levels of PTHrP, but 20% do not |
|
|
Term
| What is the cause of Hypercalcemia in FHH and how would you distinguish it from primary Hyperparathyroidism |
|
Definition
Decreased sensitivity of the parathyroid calcium receptor
FHH: has less severe symptoms and Hypocalceuria |
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Term
| Why do granulomatous disorders cause hypercalcemia |
|
Definition
| Vitamin D hydroxylation in the granulomas |
|
|
Term
| How would you evaluate a Hypercalcemic patient? |
|
Definition
PTH, if normal PTHrP, if normal 25-Vit D and 1,25-Vit D
Primary: High PTH, High 1,25
Malignancy: High PTHrP
Granulomatous: High 1,25 |
|
|
Term
| What is the treatment for Hypercalcemia |
|
Definition
Correct Problem
Renal insufficiency: Loop diuretics, IV
Bisphosphate and Calcitonin for Acute |
|
|
Term
| What are the signs and symptoms of Hypocalcemia |
|
Definition
Numbness, Paresthesia
Tetany
Chvostek's Sign: Facial Nerve Tap
Trosseau's Sign: BP cuff |
|
|
Term
| What are the causes of Hypocalcemia |
|
Definition
Thyroidectomy
Autoimmune Hypoparathyyroid
Meds
Hypomagnesium
Vit D Deficiency
Hyperphosphatemia
|
|
|
Term
| What is the evaluation of a hypocalcemic patient |
|
Definition
History
Mg, Phosphate, Creatinine, Vit D 25 and 1,25, |
|
|
Term
| what is the treatment of Hypocalcemia |
|
Definition
Treat underlying
Ca, Vit D
Ca IV if severe/symptomatic |
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