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Diabetes and Endocrine - Conditions > Clinical Calcium > Flashcards

Clinical Calcium Flashcards

1
Q

what is the normal serum calcium range

A

2.2-2.6mmol/l

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2
Q

iatrogenic cause of hypocalcaemia

A

thyroid surgery that damages the parathyroid

radiotherapy of thyroid/head and neck

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3
Q

deficiencies that cause hypocalcaemia

A

vitamin D, magnesium

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4
Q

drugs that cause hypocalcaemia

A 
cincalcet
calcium chelators
foscarnet
phenytoin
fluoride poisoning
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5
Q

what does foscarnet treat

A

viral diseases

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6
Q

how does foscarnet cause hypocalcaemia

A

it forms a complex with calcium

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7
Q

what state of calcium is caused by hypoparathyroidism

A

low calcium

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8
Q

features of pseudoparathyroidism

A

organs are resistant to PTH so PTH is high

low calcium and hairy hands

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9
Q

what condition gives you hairy hands

A

pseudoparathyroidism

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10
Q

true/false pancreatitis can cause hypocalcaemia

A

true

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11
Q

true/false malignancy can cause hypocalcaemia

A

false - commonly in neoplastic syndrome the tumour secretes PTH i.e. hypercalcaemia

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12
Q

hypo/hyper Ca2+ causes a prolonged QT interval

A

hypo

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13
Q

cardiac presentation of hypocalcaemia

A 
prolonged QT interval
hypotension
heart failure
arrhythmia
papilloedema
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14
Q

what is Chovstek’s sign

A

face relaxed, tap facial nerve in front of earlobe and the mouth will twitch

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15
Q

what is Chovstek’s sign a sign of

A

hypocalcaemia

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16
Q

acute neuro presentation of hypocalcaemia

A 
tetany
paraesthesia
carpopedal spamsm
Chovstek's sign
Trousseau's sign
laryngo/bronchospasm
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17
Q

long term consequences of hypocalcaemia on nervous system

A

calcification of basal ganglia
parkisonisms
dementia

18
Q

important things to ask on history in hypocalcaemia

A 
diet (calcium and vit D)
neck surgery
autoimmune disorders
medications that may interfere with Ca2+
FH
19
Q

significance of checking magnesium in suspected hypocalcaemia

A

magnesium is permissive to PTH and needed for it to have its effect. Therefore low Ca2+ could be caused by magnesium deficiency

20
Q

high urea and creatinine would be seen in hyper/hypo

A

hypocalcaemia

21
Q

process of 4 blood investigations

A
  1. check serum calcium
  2. check PTH
  3. a if high check magnesium
  4. b if low check urea/creatinine
  5. b if urea/creatinine normal check vitamin D
22
Q

treatment of mild hypocalcaemia

A

oral calcium, vit D or magnesium as appropriate

23
Q

what level constitutes hypercalcaemia

A

> 2.6mmol/l

24
Q

what is MEN

A

Multiple Endocrine Neoplasia inheritied syndrome

25
Q

MEN is a cause of what

A

primary hypercalcaemia

26
Q

sarcoid, TB, histioplasmosis and wegener’s all cause hyper/hypocalaemia

A

hypercalcaemi

27
Q

drugs that cause hypercalcaemia

A 
thiazide diuretics
lithium
teriparatide
vitamin A
theophylline toxicity
28
Q

acromegaly can cause hypo/hypercalcaemia

A

hypercalcaemia

29
Q

two biggest causes of hypercalcaemia

A

primary hyperparathyroidism (community) and malignancy (hospital)

30
Q

adrenal insufficiency will cause serum calcium to increase/decrease

A

increase

31
Q

true/false - being inactive can induce hypercalcaemia

A

true - loss of stimulus to build bone so Ca2+ broken down from it into plasma

32
Q

what does “bones, stones, groans and psychic moans” refer to

A

the presentation of hypercalcaemia

33
Q

key presentation of hypercalcaemia

A 
polyuria
polydipsia
kidney stones
weakness and bone pain
confusion and loss of concentration
nausea and vomiting
constipation
short QT interval
34
Q

hyper/hypocalcaemia causes a short QT interval

A

hyper

35
Q

how does high calcium affect the QT interval

A

calcium sustains the plateau phase so when there is more calcium available this stage can happen faster giving a shorter QT interval

36
Q

malignancy is more indicative of hyper/hypocalcaemia

A

hypercalcaemia - common for tumours to secrete Ca2+

37
Q

process of blood investigations in hypercalcaemia

A
  1. serum calcium
  2. corrected calcium from removing drugs or accounting for low albumin
  3. PTH
38
Q

low PTH with high Ca2+ suggests the cause is…

A

malignancy or a drug

39
Q

85% of primary hyperparathyroidism results from…

A

an adenoma of parathroids

40
Q

investigations is suspected primary hyperparathyroidism

A

Ca2+, PTH, U&Es
Parathyroid US
SESTAMIBI contrast scan for parathyroid uptake
DEXA for osteoporosis

41
Q

indications for PT surgery

A 
symptoms of hypercalcaemia
Ca2+ >2.85
osteoporosis
eGFR<60
kidney stones
<50 y/o
42
Q

Give IV _____ and fluids in hypercalcaemia

A

IV biphosphonates

Diabetes and Endocrine - Conditions (3 decks)

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