calcium metabolism and disorders Flashcards
symptoms of hypercalcaemia
- boney pain
- kidney stones
- abdominal groans
- psychic moans
acute symptoms of hypercalcaemia
- thirst
- dehydration
- confusion
- polyuria
chronic symptoms of hypercalcaemia
- myopathy
- fractures
- osteopaenia
- depression
- hypertension
- pancreatitis
- DU
- renal calculi
causes of hypercalcaemia
- primary hyperparathyroidism
- malignancy
is PTH is low then what does this mean the cause is
bone pathology
if PTH is high/normal what does this mean the cause is
- primary/tertiary hyperparathyroidism (if increased UrCa excretion)
- FHH (if decreased UrCa excretion)
if theres increased ALP what does this mean cause is
- metastases
- sarcoidosis
- thyrotoxicosis
if decreased ALP what does this mean the cause is
- myeloma
- Vit D toxicity
- milk-alkali
what confirms a diagnosis of primary hyperparathyroidism
- raised serum calcium
- raised serum PTH
- increase urine calcium excretion
what mechanisms of malignancy cause hypercalcaemia
- metastatic bone destruction
- PTHrp from solid tumours
- osteoclast activating factors
diagnosis of hypercalaemia by malignancy
- raised calcium and alkaline phosphotase
- X-ray, CT, MRI, PET
- isotope bone scan
indications for parathyroidectomy
- bone disease
- gastric ulcers
- renal stones
- osteoporosis
what happens in familial hypocalciuric hypercalaemia
the calcium sensing receptor becomes insensitive to calcium so effect on PTH is much less
- less calcium in urine
- more calcium altogether
symptoms and signs of hypocalcaemia
- paraesthesia
- muscle cramps
- muscle weakness
- fatigue
- bronchospasm or laryngospasm
- fits
- chovsteks sign
- trousseau sign
- QT prolongation on ECG
treatment of acute hypocalcaemia
EMERGENCY
- IV calcium gluconate
- infusion
causes of hypocalcaemia
- Vitamin D inadequacy or vitamin D resistance.
- Hypoparathyroidism following surgery.
- Hypoparathyroidism owing to autoimmune disease or genetic causes.
- Renal disease or end-stage liver disease causing vitamin D inadequacy.
long term management of hypocalcaemia
- calcium supplement
- vitamin D
effect of low magnesium on calcium levels
calcium release from cells is dependent on magnesium so calcium levels would be low
causes of hypomagnasaemia
- alcohol
- drugs (thiazide, PPI)
- GI illness
- pancreatitis
- malabsorption
what is pseudohypoparathyroidism
- genetic defect
- low calcium but PTH concentrations are elevated
- due to PTH resistance
symptoms of pseudohypoparathyroidism
- bone abnormalities
- obesity
- subcutaneous calcification
- learning disability
- brachydactylyl
what is pseudo-pseudohypoparathyroidism
someone with albrights hereditary osteodystrophy but no alteration in PTH action and thus normal calcium
what can vitamin D deficiency cause
rickets and osteomalacia
what could be the reason for vit D deficiency causing rickets and osteomalacia
- dietary deficiency
- malabsorption
- chronic renal failure
- lack of sunlight
- drugs
clinical presentation of osteomalacia
- low calcium
- muscle wasting
- dental defects
- bone tenderness
- fractures
- rib deformity
- limb deformity
chronic treatment of vit D deficiency
- vitamin D3 tablets
- calcitriol
- alfacalcidol
