Calcium Flashcards
Describe symptoms of hypercalcaemia.
Acute: thirst, dehydration, confusion, polyuria
Chronic: myopathy, osteopaenia, fractures, depression, hypertension, abdominal pain- pancreatitis, ulcers, renal stones
Name the causes of hypercalcaemia.
Primary hyperparathyroid malignancy vit d, thiazides granulomatous disease eg sarcoid or TB Familial hypocaliuric hypercalcaemia
How is primary hyperparathyroid diagnosed?
Raised serum calcium
Raised serum PTH (or inappropriately normal)
Increased urine calcium excretion
How is hypercalcaemia due to malignancy diagnosed?
Raised serum calcium
Raised serum PTH (or inappropriately normal)
Increased urine calcium excretion
Describe the acute treatment of hypercalcaemia.
Fluids- rehydrate with 0.9% saline 4-6L in 24hours
Consider loop diuretics once rehydrated- avoid thiazides
Bisphosphonates- single dose will lower Ca over 2-3d, maximum effect at 1 week
Steroids occasionally used e.g Pred 40-60mg/day for sarcoidosis
Salmon calcitonin- rarely used
Chemotherapy may reduce calcium in malignant disease e.g. myeloma
What are indicationds for parathyroidectomy?
End Organ Damage: Bone disease (Osteitis Fibosa et cystica; brown tumours/ pepper pot skull) Gastric ulcers Renal stones Osteoporosis
Very high Calcium (>2.85mmol/l)
Under age 50
eGFR < 60 mL/min
Describe calcium and PTH levels in all types of hyperparathyroidism.
Primary: calcium and PTH raised
Secondary: calcium LOW and PTH raised
Tertiary: calcium and PTH raised
What genetic factors might cause hyperparathyroid?
MEN1/ 2
FHPT
What ECG sign may suggest hypocalcaemia?
QT prolongation
Describe symptoms of hypocalcaemia.
Paraesthesia - fingers, toes, perioral Muscle cramps, tetany Muscle weakness Fatigue Bronchospasm or laryngospasm Fits Chovsteks sign (tapping over facial nerve) Trousseau sign (carpopedal spasm)
List causes of hypocalcaemia
Hypoparathyroidism
Vitamin D deficiency (osteomalacia, rickets)
Chronic Renal failure
How should acute hypocalcaemia be treated?
Emergency: IV calcium gluconate 10 ml, 10% over 10 mins (in 50ml saline or dextrose)
Infusion (10ml 10% in 100 ml infusate, at 50 ml/h)
Long term management of hyperparathyroidism?
Calcium supplement : > 1-2 g per day
Vitamin DTablets: 1alpha calcidol 0.5-1 mcg Depot injection: Cholecalciferol 300,000 units 6 monthly
What causes pseudohypoparathyroidism?
GENETIC Defect (dysfunction of G protein (Gs alpha subunit)- Gene= GNAS 1
What are the calcium and PTH levels in pseudohypoparathyroidism?
calcium low, PTH high
