Calcium Disorders Flashcards
Hypercalcemia most common cause
primary hyperparathyroidism (PTH) but then Primary hyperparathyroidism and cancer account for 90% of hypercalcemia patients.
Hypercalcemia cx fx and epidemiology
Most of the patients are asymptomatic. For those with severe, acute
symptomatic hypercalcemia, there is a high prevalence of cancer and the
hypercalcemia of malignancy which is from a PTH-like particle
Hypercalcemia. Less common causes
Vitamin D intoxication Sarcoidosis and other granulomatous diseases Thiazide diuretics Hyperthyroidism Metastases to bone and multiple myeloma
Acute, symptomatic hypercalcemia presents with
confusion, stupor, lethargy, and constipation.
Hypercalcemia Cardiovascular features
Short QT and hypertension
Hypercalcemia Bone lesions
Osteoporosis
HypercalcemiaRenal fx
Nephrolithiasis
Diabetes insipidus
Renal insufficiency
Hypercalcemia tx
Saline hydration at high volume
Bisphosphonates: pamidronate, zoledronic acid. they take days to work
Calcitonin (works faster than bisphosphonates) is very good for emergencies too
Furosemide is not used when urine output is adequate with hydration alone.
Dialysis would be used only for
those in_______ +hypercalcemia
renal failure
hypercalcemia
when it is from sarcoidosis or any
granulomatous disease. Tx
Prednisone
Primary hyperparathyroidism causes
Solitary adenoma (80%–85%) Hyperplasia of all 4 glands (15%–20%) Parathyroid malignancy (1%)
Primary hyperparathyroidism often presents as
an asymptomatic elevation in
calcium levels found on routine blood testing
Primary hyperparathyroidism other symptoms
signs of acute, severe hypercalcemia
Osteoporosis
Nephrolithiasis and renal insufficiency
Muscle weakness, anorexia, nausea, vomiting, and abdominal pain
Peptic ulcer disease (calcium stimulates gastrin)
hyperparathyroidism Lab test Ca PTH Phosohate level Chloride level QT segment BUN Alkaline Phosphatase
↑Ca ↑PTH ↓ Phosohate level ↑Chloride level ↓QT segment \+-↑BUN n creatinine \+-↑Alkaline Phosphatase
Additional testing for hyperparathyroidism
Bone x-ray is not a good test for
bone effects of high PTH. DEXA
densitometry is better.
hyperparathyroidism Preoperative imaging of the neck with
sonography or nuclear
scanning may be helpful in determining the surgical approach.
hyperparathyroidism tx
Surgical removal of the involved parathyroid glands is the standard of care.
When surgery is not possible, give cinacalcet. Cinacalcet inhibits the release of
PTH.
Indications for removal of parathyroids:
- Bone disease (e.g., osteoporosis)
- Renal involvement including stones
- Age under 50 years
- Calcium level consistently 1 point above normal
Primary hypoparathyroidism is most often a complication of
prior neck
surgery, such as for thyroidectomy, in which the parathyroids have been
removed
Hypocalcemia other causes
Hypomagnesemia:
Renal failure:
Vitamin D deficiency
Renal failure patho. why it causes hypoCa
The kidney converts 25 hydroxy-D to the more active 1,25 hydroxy-D
Vitamin D deficiency labs
PO4
Alkaline phosphatase
PTH
Unlike hypoparathyroidism, vitamin D deficiency has
low phosphate levels and elevated alkaline phosphatase. PTH is elevated
because calcium is low.
Choose ____________as the best test of
vitamin D levels.
25-hydroxyvitamin D
Vitamin D CxFx
Rickets: Childhood disease of impaired long bone growth and craniotabes
(soft skull bones)
Osteomalacia: Adult disease of bone impairment (milder than rickets) and
muscle pain
Hypocalcemia cx fx
Signs of neural hyperexcitability in hypocalcemia:
Chvostek sign (facial nerve hyperexcitability)
Carpopedal spasm
Perioral numbness
Mental irritability
Seizures
Tetany (Trousseau sign
Hypocalcemia Paraclínicos
EKG shows a prolonged QT that may eventually cause arrhythmia.
Slit lamp exam shows early cataracts.
Neuro cxfx
Low calcium vs
High calcium
Low calcium = twitchy and
hyperexcitable
High calcium = lethargic and slow
Hypocalcemia Tx
Replace calcium and activated vitamin D. This is done orally if symptoms are
mild or absent and intravenously if symptoms are severe.
Paget Disease of Bone PAtho
osteoclasts and osteoblasts work out of sync, deforming the bone..
Paget Disease of Bone labs
usually presents as an asymptomatic elevation in alkaline
phosphatase accompanied by normal gamma-glutamyl transpeptidase (GGTP)
and normal bilirubin, with abnormalities found on skeletal survey
Paget Disease of Bone cxfx
usually presents as asymptomatic
In symptomatic disease, the most common symptom is bone pain
Paget Disease of Bone most accurate test
nuclear (technetium) bone scan finding patchy areas of
osteoblastic activity.
Paget Disease of Bone outputs
can become
osteosarcoma
Paget disease gives high-output CHF.
Paget Disease of Bone. What is the treatment in asymptomatic disease?
No therapy needed
Paget Disease of Bone. TX When there is pain,
bisphosphonates.
Paget Disease of Bone.
When the question asks “What will relieve bone pain?” and NSAIDs have
failed or are not in the choices
choose calcitonin.
Bisphosphonate Adverse Effects
Jaw necrosis
Flulike
symptoms
Esophagitis
PPIs SE
Low calcium Low magnesium Low iron Low B12 C. difficile Pneumonia
Octreotide,
Lanreotide SE
Gallstones
Cholecystitis
Cabergoline SE
Heart valve
disease
