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Residency Exam > Calcium Magnesium Phosphate (Tutorial from29/11/23) > Flashcards

Calcium Magnesium Phosphate (Tutorial from29/11/23) Flashcards

1
Q

What is the reference range for calcium?

A

2.1 to 2.6 mmol/L

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2
Q

What is the critical value for hypercalcaemia?

A

> 3.5 mmol/L

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3
Q

What is the critical value for hypercalcaemia?

A

> 3.5 mmol/L

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4
Q

What is the critical value for hypocalcaemia?

A

<1.8 mmol/L

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5
Q

What is the critical value for hypocalcaemia?

A

<1.8 mmol/L

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6
Q

What must you always remember when interpreting serum calcium levels?

A

Calcium concentrations depend on serum albumin and pH values

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7
Q

What must you always remember when interpreting serum calcium levels?

A

Calcium concentrations depend on serum albumin and pH values

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8
Q

What are 2 common causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
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9
Q

What are 2 common causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
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10
Q

What are 2 common causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
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11
Q

What are 2 common causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
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12
Q

What are 2 common causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
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13
Q

What is a common cause of hypocalcaemia?

A

Renal impairment

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14
Q

What is a common cause of hypocalcaemia?

A

Renal impairment

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15
Q

Around what concentration do the clinical findings in hypocalcaemia include muscle spasms, tremors or tetany?

A

~ 1.5 mmol/L

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16
Q

Around what concentration do the clinical findings in hypocalcaemia include muscle spasms, tremors or tetany?

A

~ 1.5 mmol/L

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17
Q

Around what concentration do the clinical findings in hypocalcaemia include muscle spasms, tremors or tetany?

A

~ 1.5 mmol/L

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18
Q

Around what concentration do the clinical findings in hypocalcaemia include laryngospasm and suffocation?

A

~ 1.0 mmol/L

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19
Q

Around what concentration do the clinical findings in hypocalcaemia include laryngospasm and suffocation?

A

~ 1.0 mmol/L

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20
Q

Around what concentration do the clinical findings in hypocalcaemia include laryngospasm and suffocation?

A

~ 1.0 mmol/L

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21
Q

Why does hypocalcaemia lead to neuromuscular excitation?

A

With less calcium, sodium channels open more easily

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22
Q

Why does hypocalcaemia lead to neuromuscular excitation?

A

With less calcium, sodium channels open more easily

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23
Q

Why does hypocalcaemia lead to neuromuscular excitation?

A

With less calcium, sodium channels open more easily

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24
Q

Describe the ECG changes in Hypocalcaemia.

A

Hypocalcaemia causes QTc prolongation primarily by prolonging the ST segment. The T wave is typically left unchanged.

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25
Q

Describe the ECG changes in Hypocalcaemia.

A

Hypocalcaemia causes QTc prolongation primarily by prolonging the ST segment. The T wave is typically left unchanged.

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26
Q

What is a rhyming phrase for the symptoms of hypercalcaemia secondary to hyperparathyroidism?

A

Moans (CNS), bones (bone pain) groans (GI tract disturbances) and stones (nephrolithiasis)

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27
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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28
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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29
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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30
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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31
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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32
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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33
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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34
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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35
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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36
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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37
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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38
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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39
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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40
Q

What is a rhyming phrase for the symptoms of hypercalcaemia secondary to hyperparathyroidism?

A

Moans (CNS), bones (bone pain) groans (GI tract disturbances) and stones (nephrolithiasis)

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41
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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42
Q

Why does hypercalcaemia cause kidney stones?

A

Due to calcium deposits in the urine

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43
Q

What are 6 causes of hypocalcaemia?

A
  1. Vitamin D deficiency
  2. Chronic kidney disease
  3. Hypoparathyroidism
  4. Hyperphosphatemia
  5. Pancreatitis
  6. Drugs
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44
Q

What are 5 drugs which may cause hypercalcaemia?

A
  1. Thiazide diuretics
  2. Lithium
  3. Vitamin D
  4. Teriparatide
  5. Calcium supplements
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45
Q

What are 5 drugs which may cause hypercalcaemia?

A
  1. Thiazide diuretics
  2. Lithium
  3. Vitamin D
  4. Teriparatide
  5. Calcium supplements
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46
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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47
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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48
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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49
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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50
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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51
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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52
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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53
Q

If calcium is high, and parathyroid hormone is low, what is this indicative of?

A

Hypercalcaemia of malignancy

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54
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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55
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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56
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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57
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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58
Q

What are 7 drugs which may cause hypocalcaemia?

A
  1. Loop diuretics
  2. Calcitonin
  3. Romosozumab
  4. Phosphate Binders
  5. Cinacalcet
  6. Bisphosphonates
  7. Denosumab
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59
Q

If calcium is high, and parathyroid hormone is low, what is this indicative of?

A

Hypercalcaemia of malignancy

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60
Q

What is a common cause of hypophosphataemia?

A

Refeeding syndrome

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61
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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62
Q

What are the mechanisms by which thiazide diuretics cause hypercalcaemia?

A

They increase proximal sodium/water reabsorption secondary to volume depletion, leading to increased passive proximal calcium reabsorption. They also increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

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63
Q

What are the mechanisms by which thiazide diuretics cause hypercalcaemia?

A

They increase proximal sodium/water reabsorption secondary to volume depletion, leading to increased passive proximal calcium reabsorption. They also increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

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64
Q

If calcium is high, and parathyroid hormone is low, what is this indicative of?

A

Hypercalcaemia of malignancy

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65
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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66
Q

What are 5 drugs which may cause hypercalcaemia?

A
  1. Thiazide diuretics
  2. Lithium
  3. Vitamin D
  4. Teriparatide
  5. Calcium supplements
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67
Q

What are the mechanisms by which thiazide diuretics cause hypercalcaemia?

A

They increase proximal sodium/water reabsorption secondary to volume depletion, leading to increased passive proximal calcium reabsorption. They also increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

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68
Q

What are 3 causes of hypercalcaemia?

A
  1. Malignancy
  2. Hyperparathyroidism
  3. Drugs
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69
Q

What are the mechanisms by which thiazide diuretics cause hypercalcaemia?

A

They increase proximal sodium/water reabsorption secondary to volume depletion, leading to increased passive proximal calcium reabsorption. They also increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

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70
Q

What are 5 drugs which may cause hypercalcaemia?

A
  1. Thiazide diuretics
  2. Lithium
  3. Vitamin D
  4. Teriparatide
  5. Calcium supplements
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71
Q

What are the mechanisms by which thiazide diuretics cause hypercalcaemia?

A

They increase proximal sodium/water reabsorption secondary to volume depletion, leading to increased passive proximal calcium reabsorption. They also increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

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72
Q

What are 5 drugs which may cause hypercalcaemia?

A
  1. Thiazide diuretics
  2. Lithium
  3. Vitamin D
  4. Teriparatide
  5. Calcium supplements
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73
Q

What are the mechanisms by which lithium causes hypercalcaemia?

A

Lithium may induce increased calcium reabsorption within the loop of Henle. It may also alter feedback mechanisms within the parathyroid gland, impeding the suppression of PTH normally produced by hypercalcemia.

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74
Q

If calcium is high, and parathyroid hormone is high, what is this indicative of?

A

Primary hyperparathyroidism

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75
Q

If calcium is high, and parathyroid hormone is high, what is this indicative of?

A

Primary hyperparathyroidism

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76
Q

If calcium is high, and parathyroid hormone is low, what is this indicative of?

A

Hypercalcaemia of malignancy

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77
Q

How do Loop Diuretics affect serum calcium concentrations?

A

Loop diuretics decrease serum calcium concentrations

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78
Q

How do Loop Diuretics affect serum calcium concentrations?

A

Loop diuretics decrease serum calcium concentrations

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79
Q

What is the most common cause of hypocalcaemia?

A

Chronic kidney disease

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80
Q

If calcium is low, what is the body’s usual response?

A

Parathyroid hormone is released to dissolve bone to restore ionised (free) calcium

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81
Q

If calcium is low, what is the body’s usual response?

A

Parathyroid hormone is released to dissolve bone to restore ionised (free) calcium

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82
Q

If calcium is high, and parathyroid hormone is high, what is this indicative of?

A

Primary hyperparathyroidism

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83
Q

If calcium is high, and parathyroid hormone is low, what is this indicative of?

A

Hypercalcaemia of malignancy

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84
Q

What is low calcium and high parathyroid hormone indicative of?

A

Secondary hyperparathyroidism

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85
Q

What is low calcium and high parathyroid hormone indicative of?

A

Secondary hyperparathyroidism

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86
Q

What is low calcium and high parathyroid hormone indicative of?

A

Secondary hyperparathyroidism

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87
Q

How do Loop Diuretics affect serum calcium concentrations?

A

Loop diuretics decrease serum calcium concentrations

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88
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion (i.e. hyperparathyroidism)
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
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89
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion (i.e. hyperparathyroidism)
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
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90
Q

How do Loop Diuretics affect serum calcium concentrations?

A

Loop diuretics decrease serum calcium concentrations

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91
Q

What are the mechanisms by which thiazide diuretics cause hypercalcaemia?

A

They increase proximal sodium/water reabsorption secondary to volume depletion, leading to increased passive proximal calcium reabsorption. They also increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

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92
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion (i.e. hyperparathyroidism)
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
93
Q

What is the reference range for phosphate?

A

0.75 to 1.5 mmol/L

94
Q

What is the critical value for hyperphosphataemia?

A

> 2.6 mmol/L

95
Q

What is the critical value for hyperphosphataemia?

A

> 2.6 mmol/L

96
Q

How does sodium affect calcium?

A

Sodium interferes with the resorption of calcium in the proximal tubule

97
Q

What are the mechanisms by which lithium causes hypercalcaemia?

A

Lithium may induce increased calcium reabsorption within the loop of Henle. It may also alter feedback mechanisms within the parathyroid gland, impeding the suppression of PTH normally produced by hypercalcemia.

98
Q

What is the critical value for hyperphosphataemia?

A

> 2.6 mmol/L

99
Q

What is a common cause of hypophosphataemia?

A

Refeeding syndrome

100
Q

What is a common cause of hypophosphataemia?

A

Refeeding syndrome

101
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
102
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
103
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
104
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
105
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
106
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
107
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion (i.e. hyperparathyroidism)
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
108
Q

What is the first step in the management of severe hypercalcaemia.

A

Hydration with isotonic saline.

109
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion (i.e. hyperparathyroidism)
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
110
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
111
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
112
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
113
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
114
Q

How does sodium affect calcium?

A

Sodium interferes with the resorption of calcium in the proximal tubule

115
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
116
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
117
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
118
Q

How does sodium affect calcium?

A

Sodium interferes with the resorption of calcium in the proximal tubule

119
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
120
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
121
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
122
Q

How does loading with normal saline affect calcium?

A

This causes calciuresis

123
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
124
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
125
Q

What is hyperphosphataemia often caused by?

A

Renal impairment

126
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
127
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
128
Q

What is the critical value for hypophosphataemia?

A

<0.3 mmol/L

129
Q

How does ferric carboxymaltose cause hypophosphataemia?

A

By stimulating an increase in fibroblast growth factor-23, increasing renal phosphate clearance

130
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
131
Q

What is the critical value for hypophosphataemia?

A

<0.3 mmol/L

132
Q

What is the reference range for phosphate?

A

0.75 to 1.5 mmol/L

133
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
134
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
135
Q

What is a common cause of hypophosphataemia?

A

Refeeding syndrome

136
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
137
Q

What are 3 causes of hyperphosphataemia?

A
  1. RENAL FAILURE
  2. Extracellular shifting
  3. Increased intake of phosphate or Vitamin D
138
Q

What is the critical value for hyperphosphataemia?

A

> 2.6 mmol/L

139
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
140
Q

What is the critical value for hypophosphataemia?

A

<0.3 mmol/L

141
Q

What are 3 causes of hyperphosphataemia?

A
  1. RENAL FAILURE
  2. Extracellular shifting
  3. Increased intake of phosphate or Vitamin D
142
Q

What are 3 causes of hyperphosphataemia?

A
  1. RENAL FAILURE
  2. Extracellular shifting
  3. Increased intake of phosphate or Vitamin D
143
Q

What is hyperphosphataemia often caused by?

A

Renal impairment

144
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
145
Q

What is a common cause of hypophosphataemia?

A

Refeeding syndrome

146
Q

What are 3 causes of hypophosphataemia?

A
  1. Increased renal excretion
  2. Intracellular shifting
  3. Decreased intake of phosphate or vitamin D
147
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
148
Q

What are 3 causes of hyperphosphataemia?

A
  1. RENAL FAILURE
  2. Extracellular shifting
  3. Increased intake of phosphate or Vitamin D
149
Q

What are 3 examples of conditions leading to malabsorption of phosphate in the small intestine?

A
  1. Crohn’s disease
  2. Celiac disease
  3. Malabsorption of Vitamin D
150
Q

What is commonly used to prevent hyperphosphataemia in chronic kidney disease?

A

Phosphate binders such as sevelamer

151
Q

What are 6 causes of hypophosphatemia related to decreased intake?

A
  1. Total parenteral nutrition
  2. Malabsorption disease of small intestine
  3. Magnesium or aluminium-based antacids
  4. Starvation - loss of phosphate in urine
  5. Diet inadequate
  6. Increased urinary losses due to tubular dysfunction
152
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
153
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
154
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
155
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
156
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
157
Q

What are 6 hormonal causes of hypophosphataemia?

A
  1. Insulin
  2. Glucagon
  3. Cortisol
  4. Glucose
  5. Fructose
  6. Lactate
158
Q

What are 6 hormonal causes of hypophosphataemia?

A
  1. Insulin
  2. Glucagon
  3. Cortisol
  4. Glucose
  5. Fructose
  6. Lactate
159
Q

Which patients are typically given calcitriol?

A

Patients with renal impairment

160
Q

How may total parenteral nutrition cause hypophosphataemia?

A

If the concentration of phosphate is too low

161
Q

What are 6 hormonal causes of hypophosphataemia?

A
  1. Insulin
  2. Glucagon
  3. Cortisol
  4. Glucose
  5. Fructose
  6. Lactate
162
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
163
Q

What are 6 hormonal causes of hypophosphataemia?

A
  1. Insulin
  2. Glucagon
  3. Cortisol
  4. Glucose
  5. Fructose
  6. Lactate
164
Q

What are 3 examples of conditions leading to malabsorption of phosphate in the small intestine?

A
  1. Crohn’s disease
  2. Celiac disease
  3. Malabsorption of Vitamin D
165
Q

How do magnesium and aluminium-based antacids lead to hypophosphataemia?

A

They form insoluble complexes in intestine

166
Q

What is a common cause of hungry bone syndrome?

A

Parathyroidectomies

167
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
168
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
169
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
170
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
171
Q

What are 6 causes of hypophosphatemia caused by redistribution?

A
  1. Respiratory alkalosis (hyperventilating)
  2. Recovery from diabetic ketoacidosis
  3. Hormonal and other agents
  4. Sepsis
  5. Recovery from malnutrition
  6. Hungry bone syndrome
172
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
173
Q

What are 6 hormonal causes of hypophosphataemia?

A
  1. Insulin
  2. Glucagon
  3. Cortisol
  4. Glucose
  5. Fructose
  6. Lactate
174
Q

What is a common cause of hungry bone syndrome?

A

Parathyroidectomies

175
Q

What is the mechanism by which refeeding syndrome occurs?

A

When the body is in a starved state, any nutrients supplied to it will be drawn into cells, depleting the concentration in the plasma

176
Q

How does ferric carboxymaltose cause hypophosphataemia?

A

By stimulating an increase in fibroblast growth factor-23, increasing renal phosphate clearance

177
Q

What are 3 activities of fibroblast growth factor-23 on phosphate assuming kidneys are functioning properly?

A
  1. Increased urinary excretion of phosphate
  2. Reduced renal production of calcitriol
  3. Decreased PTH secretion
178
Q

What are 8 types of cancer which may cause hypercalcaemia?

A
  1. Lung cancer
  2. Multiple myeloma
  3. Breast cancer
  4. Prostate cancer
  5. Kidney cancer
  6. Ovarian cancer
  7. Myeloma
  8. Lymphosarcoma
179
Q

What must you remember when administering pamidronate?

A

It may take a few days to work, so monitoring should be performed accordingly

180
Q

Which patients are typically given calcitriol?

A

Patients with renal impairment

181
Q

Why is calcitriol usually reserved for renal patients?

A

Calcitriol is the product a healthy functioning kidney produces from colecalciferol, and it is much more active

182
Q

How does calcium supplementation affect phosphate?

A

Calcium supplements reduce phosphate

183
Q

What is the expected aetiology of calciphylaxis?

A

Calciphylaxis is thought to occur due to occlusion of blood vessels by thrombi and calcium deposits

184
Q

What is a common group of patients who commonly have low magnesium?

A

Alcoholics

185
Q

If you have a low calcium and a low potassium, what should you always check?

A

Magnesium

186
Q

How does respiratory aklalosis (i.e. hyperventilation) affect phosphate?

A

Respiratory alkalosis decreases serum phosphate concentrations

187
Q

What is a common group of patients who commonly have low magnesium?

A

Alcoholics

188
Q

What is milk-alkali syndrome?

A

A triad of hypercalcaemia, metabolic alkalosis, and acute kidney injury

189
Q

What is a common group of patients who commonly have low Vitamin D?

A

Patients with Crohn’s disease

190
Q

What is milk alkali syndrome?

A

A triad of hypercalcaemia, metabolic alkalosis, and acute kidney injury

191
Q

What is milk-alkali syndrome?

A

A triad of hypercalcaemia, metabolic alkalosis, and acute kidney injury

192
Q

How does sepsis affect phosphate?

A

Sepsis decreases serum phosphate concentrations

193
Q

Why does hypocalcaemia lead to neuromuscular excitation?

A

With less calcium, sodium channels open more easily

194
Q

How does respiratory aklalosis (i.e. hyperventilation) affect phosphate?

A

Respiratory alkalosis decreases serum phosphate concentrations

195
Q

How does hyperparathyroidism affect calcium?

A

Hyperparathyroidism increases serum calcium concentration

196
Q

How does recovery from diabetic ketoacidosis affect phosphate?

A

Recovery from diabetic ketoacidosis decreases serum phosphate concentrations

197
Q

How does sepsis affect phosphate?

A

Sepsis decreases serum phosphate concentrations

198
Q

How does recovery from malnutrition affect phosphate?

A

Recovery from malnutrition decreases serum phosphate concentrations

199
Q

How does chronic kidney disease affect calcium?

A

Chronic kidney disease decreases serum calcium concentrations

200
Q

How does hungry bone syndrome affect phosphate?

A

Hungry bone syndrome decreases serum phosphate concentrations

201
Q

How does vitamin D intake effect phosphate?

A

Phosphate levels are positively associated with vitamin D

202
Q

How does vitamin D deficiency affect calcium?

A

Vitamin D deficiency decreases serum calcium concentrations

203
Q

How does chronic kidney disease affect calcium?

A

Chronic kidney disease decreases serum calcium concentrations

204
Q

How does hypoparathryoidism affect calcium?

A

Hypoparathyroidism decreases serum calcium concentrations

205
Q

How does hyperphosphataemia affect calcium?

A

Hyperphosphataemia decreases serum calcium concentrations

206
Q

How does pancreatitis affect calcium?

A

Pancreatitis decreases serum calcium concentrations

207
Q

How does pancreatitis affect calcium?

A

Pancreatitis decreases serum calcium concentrations

208
Q

How does hyperparathyroidism affect calcium?

A

Hyperparathyroidism increases serum calcium concentration

209
Q

How does hyperparathyroidism affect calcium?

A

Hyperparathyroidism increases serum calcium concentration

210
Q

How is phosphate primarily cleared?

A

By the kidneys

211
Q

How does renal impairment affect phosphate?

A

Renal impairment increases serum phosphate concentrations

212
Q

How does vitamin D intake effect phosphate?

A

Phosphate levels are positively associated with vitamin D

213
Q

How do parathyroid levels affect calcium levels?

A

High parathyroid levels increase calcium levels by increasing resorption of calcium from the bone

214
Q

What is the relationship between phosphate and calcium levels?

A

Calcium and phosphate have an inverse relationship

215
Q

How does pancreatitis affect calcium?

A

Pancreatitis decreases serum calcium concentrations

216
Q

How do thiazide diuretics affect calcium?

A

Thiazide diuretics increase serum calcium

217
Q

How do thiazide diuretics affect proximal sodium/water reabsorption secondary to volume depletion?

A

They increase proximal sodium/water reabsorption secondary to volume depletion

218
Q

How does the increased proximal sodium/water reabsorption secondary to volume depletion caused by thiazide diuretics affect calcium levels?

A

This leads to increased passive proximal calcium reabsorption.

219
Q

How do thiazide diuretics affect distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment?

A

Thiazide diuretics increase distal calcium reabsorption at the thiazide-sensitive site in the distal tubule and connecting segment

220
Q

How does parathyroid hormone affect phosphate?

A

Parathyroid hormone decreases phosphate concentrations by inhibiting reabsorption at the proximal convoluted tubule

221
Q

Which form of alkalosis is more commonly implicated in causing hypophosphataemia?

A

Respiratory alkalosis

222
Q

What is the mechanism by which loop diuretics decrease serum calcium concentrations?

A

They facilitate urinary excretion of calcium, inhibiting calcium reabsorption in the thick ascending limb of the loop of Henle.

223
Q

How does cortisol affect phosphate concentrations?

A

Cortisol lowers serum phosphate concentrations

224
Q

How does insulin affect phosphate concentrations?

A

Insulin lowers serum phosphate concentrations

225
Q

How does glucose affect phosphate concentrations?

A

Glucose lowers serum phosphate concentrations

226
Q

How does glucagon affect phosphate concentrations?

A

Glucagon lowers serum phosphate concentrations

227
Q

How does lactate affect phosphate concentrations?

A

Lactate lowers serum phosphate concentrations

228
Q

How does fructose affect phosphate concentrations?

A

Fructose lowers serum phosphate concentrations

Residency Exam (22 decks)

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