50 - Hypercalcemia and Hypocalcemia Flashcards
In which mechanisms is calcium involved?
- Cell signaling
- Cardiac contractility
- Hormone release
- Coagulation
What are the etiological groups for hypercalcemia? (5)
- Elevated PTH
- PTH related peptide
- Granulomatous disease
- Primary increase in bone resorption
- Excessive calcium intake
High levels of PTH is usually due to a ___ or ____
Parathyroid neoplastic problem
Familial Hypocalciuric hypercalcemia (FHH)
PTH related peptide is secreted from ___ and acts as PTH on the ____ and the ___. In this case there will be low levels of ___
Solid tumors
Bone
Kidney
PTH
In granulomatous disease (___,___) there’s a high turnover of ___, leading to increased absorption of __ in the __, leading to ___ + hypercalcemia
Sarcoidosis Lymphoma Vitamin D Calcium GI Decreased PTH
___ or ___can cause increased bone turnover. ___ will be low
Hyperthyroidism
Lytic lesion
PTH
Minor hypercalcemia (___) is usually ___. symptoms may include: ___, ___, ___.
11-11.5 mg/dL Asymptomatic Neuropsychiatric PUD Nephrolithiasis
More severe hypercalcemia (___) may lead to ___ and even ___, alongside other ___ symptoms and ___
12-13 mg/dL Lethargy Coma GI Pancreatitis
Hypercalcemia damages the ability of the kidney leading to ___ and ___
Polydipsia
Polyuria
Cardiac symptoms of hypercalcemia include: (3)
- AV block
- Short QT
- Bradycardia
What is the first step when diagnosing hypercalcemia?
Make sure it is not secondary to albumin level
How do you calculate corrected calcium level?
Blood Ca+0.8(4.1-serum albumin)
What are the two most common causes for hypercalcemia?
- Primary hyperparathyroidism
2. Malignancy
Once hypercalcemia is diagnosed what should we test for?
PTH levels
High PTH usually accompanied by ___
Hypophosphatemia
What is the cause for: normal-high PTH + hypercalcemia + hypophosphatemia
Primary hyperparathyroidism
What should we rule out when suspecting primary hyperparathyroidism?
FHH (familial hypercalciuric hypercalcemia)
What can be ruled out as the cause for hypercalcemia when PTH is low? What will be the probable cause?
Parathyroid
Malignancy
What is the treatment for minor asymptomatic hypercalcemia?
No treatment- look for the cause
What is the treatment to significant hypercalcemia?
Immediate treatment with volume expansion
What does volume expansion treatment for hypercalcemia include?
4-6 liters of NS in the first 24 hours.
Name common drugs for hypercalcemia treatment in patients with malignancy. When do they start working?
Bisphosphonates
Ibandronate
Pamidronate
1-3 days
How will you treat patients with active vitamin D dependent hypercalcemia?
Steroids- Hydrocortisone IV or prednisone PO
What are the two common causes for hypocalcemia?
PTH synthesis problem
Vitamin D
Low levels of PTH can be related to ___ or ___ which inhibit PTH (the opposite of ___)
Hypomagnesemia
CASR activating mutation
FHH
Hypocalcemia occurs also in cases with hypoalbuminemia + hyperphosphatemia -> calcium tissue deposition-> PTH secretion issues. The main reasons for that are: (4)
Burns
Rhabdomyolysis
Tumor lysis
Pancreatitis
Severe hypocalcemia clinical manifestations include:
Chvostek sign Trousseau's sign Seizures Bronchospasm/ Laryngospasm Elongated QT
What is the 1st step when diagnosing hypocalcemia?
Measuring calcium, albumin, phosphor, magnesium
After taking electrolytes, what is the 2nd step when diagnosing hypocalcemia?
Measuring PTH
If a patient with hypocalcemia has low PTH levels, what should you ask?
Reasons for destruction/damage of the parathyroid gland
If a patient with hypocalcemia has highPTH levels, what should you ask?
Look for vitamin D problems (storage or renal issues)
What is the first line treatment of hypocalcemia?
Calcium gluconate
Chronic hypercalcemia secondary to hypoparathyroidism is treated with:
Calcium supplements + vitamin D
