Calcium Disorders

Question 1

A patient presents with perioral numbness, peripheral paresthesias and Chvostek’s sign. What is the cause of these signs? What is the treatment?

Answer 1

Acute hypocalcemia: ABCs, IV calcium gluconate, oral Ca+

Question 2

What are the 3 main tetany findings of hypocalcemia?

Answer 2

Chvostek’s sign (hyper-excitability of the facial nerves), Trousseau’s sign (hand clenches in weird configuration with occlusion of the radial blood supply), and layrngospasm (life threatening)

Question 3

A patient presents with hypocalcemia. They have low PTH, increased urine calcium, decreased 1-25 vic D, and normal 25-vit D. What is your diagnosis? What are some potential causes?

Answer 3

Hypoparathyroidism; usually acquired via post-op thyroid/neck surgery or autoimmune. It can also be caused by radiation, infiltrative disease (sarcoid) and hypoMg.

Question 4

A patient presents with hypocalcemia. The PTH is high and 25-OH vit D is very low. What is your diagnosis?

Answer 4

The most likely cause of these findings are a result of malabsorption/GI disease/short gut. It could also be due to liver failure (liver makes 25-OH vit D) or vit D degradation via anti-convulsants etc.

Question 5

A patient presents with polyuria with resultant polydipsia and a cognitive impairment. What calcium abnormality do you expect to find on investigation?

Answer 5

Hypercalcemia

Question 6

What do you see in primary hyperparathyroidism?

a. low PTH
b. low calcium
c. low PTHrp
d. high PO4
e. low 1,25 (OH) vit D

Answer 6

c. low PTHrp