Calcium stuff Flashcards

1
Q

What is hypercalcaemia?

A

Hypercalcemia refers to a higher than normal calcium levels in the blood, generally over 10.5 mg/dL.

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2
Q

Aetiology of hypercalcaemia

A

Acidosis: promotes less binding between albumin and calcium. This causes less bound calcium and more free ionised calcium
- osteoclastic bone resorption due to:
- Hyperparathyroidism
- Malignant tumours
Excess vitamin D: increased calcium absorption from GI tract
- Medications
- Thiazide diuretics increases calcium reabsorption in the distal tubule of the kidney
- Lithium

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3
Q

Pathophysiology of hypercalcaemia

A

With high levels of extracellular calcium, voltage-gated sodium channels are less likely to open up, which makes it harder to reach depolarisation, and makes the neuron less excitable.
Causes:

  • slower or absent reflexes
  • The sluggish firing of neurons also leads to slower muscle contraction, which causes constipation and generalised muscle weakness.
  • In the central nervous system, hypercalcaemia causes confusion, hallucinations, and stupor.
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4
Q

What is hypercalciuria?

A

Too much calcium in the blood
leads to a loss of excess fluid in the kidneys causing an individual to get dehydrated.

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5
Q

S+S of hypercalcaemia?

A
  • Abdominal pain
  • Vomiting
  • Constipation
  • Dehydration
  • Polydipsia
  • Polyuria
  • Absent reflexes
  • Muscle weakness
  • Weight loss
  • Depression
  • Confusion
  • Hallucinations
  • Stupor
  • Hypertension
  • Pyrexia
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6
Q

Investigations for Hypercalcaemia?

A
  • Bloods: high calcium. Also check parathyroid hormone, vitamin D, albumin, phosphorus, and magnesium levels.
    • In malignancy, there is low albumin, low chloride, alkalosis, low potassium, high phosphate, high ALP
    • Hyperparathyroidism: high PTH
  • 24 hr urinary Ca2+ excretion: raised
  • Electrocardiogram: tachycardia, AV block, shortening of the QT interval, and sometimes in the precordial leads the appearance of an J wave
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7
Q

Imaging for Hypercalcaemia

A
  • Chest X-ray
  • Isotope bone scan
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8
Q

Differential diagnosis for hypercalcaemia

A

Hyperalbuminaemia (pseudohypocalcaemia): causes there to be a higher concentration of protein-bound calcium, while free ionised calcium concentrations stay the same. This can occur when individuals are dehydrated, concentrating albumin.

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9
Q

Management for hypercalcaemia

A
  • Increase urinary calcium excretion
    • Rehydration: increases filtering of Ca2+
    • Loop diuretics: inhibit calcium reabsorption in the loop of Henle
  • Decrease calcium absorption from GI tract
    • Glucocorticoids
  • Prevention of bone resorption
    • Biphosphonates
    • Calcitonin
  • Chemotherapy may help in malignancy
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10
Q

Complications of hypercalcaemia

A
  • Kidney stones: due to dehydration combined with hypercalciuria
  • Renal failure
  • Ectopic calcification e.g. cornea
  • Cardiac arrest
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11
Q

What is hypocalcaemia?

A

Hypocalcemia refers to lower than normal calcium levels in the blood, generally less than 8.5 mg/dL.

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12
Q

Aetiology of hypocalcaemia with increased phosphate

A
  • Chronic kidney disease: lack of reabsorption of Ca2+, lack of active vitamin D
  • Hypoparathyroidism: e.g. due to removal of or autoimmune destruction PT glands, DiGeorge syndrome
  • Pseudohypoparathyroidism
  • Acute rhabdomyolysis: large numbers of cells die and release phosphate. The phosphate binds to the ionised calcium and forms calcium phosphate, making it insoluble and effectively decreasing the total amount in blood.
  • Hypomagnesaemia: magnesium is needed for PTH secretion
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13
Q

Aetiology with normal or low phosphate for hypocalcaemia?

A
  • Vitamin D deficiency: leads to less Ca2+ absorption from GI tract
  • Osteomalacia
  • Acute pancreatitis: free fatty acids end up binding to ionised calcium, which is insoluble and precipitates.
  • Over-hydration
  • Respiratory alkalosis: high pH (alkalosis) causes more binding between albumin and calcium, which results in less free ionised calcium
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14
Q

Pathophysiology of hypocalcaemia

A

Low levels of ionised calcium affect a variety of cellular processes e.g.

  • With low levels of extracellular calcium, voltage-gated sodium channels are less stable and more likely to open up, which allows the cell to depolarise more easily, and makes the neurone more excitable. This can trigger tetany.
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15
Q

S+S of hypocalcaemia Pneumonic

A

SPASMODIC

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16
Q

SPASMODIC

A

Spasms
- Perioral numbness/ paraesthesiae
- Anxious, irritable, irrational
- Seizures
- Muscle tone increases: colic, wheeze and dysphagia
- Orientation impaired and confusion
- Dermatitis
- Impetigo herpetiformis (severe pustular psoriasis occurring in pregnancy)
- Chvosteks sign

17
Q

Investigations for hypocalcaemia

A
  • Bloods: low calcium. Also check for parathyroid hormone, vitamin D, albumin, phosphorus, and magnesium levels.
  • Electrocardiogram: may show prolonged QT, prolonged ST segment, and arrhythmias e.g. torsade de pointes and atrial fibrillation.
18
Q

Differential diagnosis of hypocalacemia

A

Hypoalbuminaemia (pseudohypocalcaemia): there is a loss of bound calcium but free ionised levels remain the same

19
Q

Management of hypocalcaemia

A
  • Calcium supplements e.g. calcium gluconate
  • Vitamin D supplementation e.g. alfacalcidol, if appropriate
  • If alkalosis, correct alkalosis