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Endocrine > 2: Hyper- and HypoCalcaemia > Flashcards

2: Hyper- and HypoCalcaemia Flashcards

1
Q

Define Hypercalcaemia

A

Calcium >2.62

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2
Q

What is the most common cause of hypercalcaemia in non-hospitalised patients

A

Primary hyperparathyroidism

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3
Q

What is the most common cause of hypercalcaemia in hospitalised patients

A

Malignancy

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4
Q

In determined the aetiology of hypercalcaemia what is first looked at

A

Albumin

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5
Q

If albumin is raised, what electrolyte is the looked at

A

Urea

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6
Q

if albumin raised, urea raised - what is the likely cause of hypercalcaemia

A
  • Dehydration
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7
Q

if albumin raised, urea normal - what is the likely cause of hypercalcaemia

A
  • Cuffed specimen
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8
Q

if albumin is normal/low what is then looked at

A

Phosphate

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9
Q

If phosphate is low what is suspected

A
  • Hyperparathyroidism
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10
Q

If phosphate is high what marked is looked at

A

ALP

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11
Q

What may cause hypercalcaemia with raised ALP

A
  • Bone mets
  • Thyrotoxicosis
  • Lithium
  • Myeloma
  • Vitamin D excess
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12
Q

What may cause hypercalcaemia and normal ALP

A
  • Milk Alkali syndrome

- Sarcoidosis

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13
Q

How can milk-alkali syndrome be distinguished

A

Raised bicarbonate

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14
Q

What is mnemonic for symptoms in hypercalcaemia

A

Stones, Bones, Groans, Psychic Overtones

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15
Q

What investigations are ordered for hypercalcaemia

A
  • Bone Profile (Calcium, Phosphate, PTH)
  • Serum Magnesium
  • ECG
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16
Q

What finding will be present on ECG in hypercalcaemia

A

Shortened QT Interval

17
Q

If mild hypercalcaemia, how is it managed

A

Encourage Oral Fluid Intake

Reduce calcium in diet

18
Q

at what calcium level do you treat

A

> 3.5 or symptomatic

19
Q

what is first-line to lower high serum calcium

A

0.9% IV Saline

20
Q

what medication is given for hypercalcaemia

A

Bisphosphates (Aledronic acid, Zoledronic acid)

21
Q

what other management is offered for hypercalcaemia

A

Prednisolone - Sarcoidosis
Manage Malignancy
Parathyroidectomy - If Hyperparathyroidism

22
Q

explain use of loop diuretics in hypercalcaemia

A

Loop diuretics can reduce calcium. However, they also cause dehydration which can precipitate high calcium. Therefore should only be used as a treatment when patient is fully rehydrated.

23
Q

what serum calcium concentration defines hypocalcaemia

A

Less than 2.12

24
Q

what should be ordered in low calcium

A

Phosphate

25
Q

What are 5 causes of calcium with raised phosphate

A
  1. CKD
  2. Hypoparathyroidism
  3. Hypomagnesaemia
  4. Rhabdomyolysis (Acute)
  5. Psydohypoparathyroidism
26
Q

What are 5 causes of hypocalcaemia with normal phosphate

A
  • Vitamin D Deficeincy
  • Osteomalacia
  • Over-hydration
  • Respiratory alkalosis
  • Pancreatitis
27
Q

How can osteomalacia be identified

A

Raised ALP

28
Q

What can cause over-hydration

A

Massive blood transfusion

29
Q

Explain respiratory alkalosis as a cause of hypocalcaemia

A

Respiratory alkalosis causes decrease in free ionised calcium and NOT total calcium.

This is because alkalosis increases ability of proteins (eg. albumin) to bind anions such as calcium

30
Q

What is the mnemonic to remember symptoms of hypocalcaemia

A

SPASMODIC

31
Q

What are the symptoms of hypocalcaemia

A

Spasms (Trousseaus, Chovstek)

Peri-oral parasthesia

Anxious, Irritable

Seizures

Muscle tone Increase

Orientation Impaired

Dermatitis

Impetigo herpetiformis

Coreoathetosis, cataracts, cardiomyopathy

32
Q

What is impetigo herpetiformis

A

Hypocalcaemia and pustules in pregnancy

33
Q

What investigations are ordered in hypocalcaemia

A
  • Bone profile
  • Magnesium
  • ECG: prolong QT
34
Q

What is given in acute hypocalcaemia

A

Calcium gluconate

35
Q

If individual is not responding to calcium gluconate what is suspected

A

Low magnesium - supplement with magnesium

36
Q

If hypocalcaemia due to CKD what is given

A

1a calcidol (vitamin D)

Endocrine (20 decks)

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