Clinical Chemistry CPC Flashcards
What part of the body is affected in a Colles’ fracture
Wrist
What part of the body is affected in a Pott’s fracture
Ankle fracture - involved tibia and fibula
What is the normal range for calcium
2.2-2.6
What are the causes of hypercalcaemia (3)
Cancer
Primary hyperPTH
Sarcoidosis
How can you determine the cause of high calcium
Measure PTH
What causes the majority of primary hyperPTH
Parathyroid adenomas
What are the consequences of primary hyperPTH (3)
Efflux of calcium from bone
Decreased loss of calcium in urine
Enhanced absorption of calcium from intestines
What indicates primary hyperPTH (2)
Raised/inappropriately normal PTH in the presence of hypercalcaemia
Raised calcium Low phosphate Raised/normal PTH Raised/normal ALP Normal Vitamin D
HyperPTH
Clinical features of hypercalcaemia (6)
Moans/Bones/Groans/Stones
Asymtpomatic
Polydypsia/polyuria (nephrogenic DI)
Signs of hypercalcaemia
Band keratopathy
Complications of hypercalcaemia (5)
Renal stones Pancreatitis Peptic ulcer disease Skeletal changes Ostetitis fibrosa et cystica
What are the types of renal stones (3)
Calcium oxalate-monohydrate
Calcium phosphate
Uric acid
Uric acid renal stones
Radiolucent
Calcium renal stones
Radio opaque
Risk factors for calcium renal stones (5)
Family history Dewhydration Hypercalciuria (>6mmol Ca/day) Hypercalcaemia HyperPTH
How do calcium renal stones present (4)
Pain (colic)
Haematuria
Recurrent infection
Renal failure
Investigations for renal stones (3)
KUB
Stone analysis
Urine and serum biochemistry
Natural history of calcium renal stones
Most stones pass
How are calcium renal stones treated if they do not pass (3)
Lithotrypsy
Cystoscopy
Lithotomy
How can calcium renal stones be prevented (2)
Drink more water Treat hypercalciuria (e.g. thizides) and/or hypercalcaemia as necessary
What warrants emergency management of hypercalcaemia
Calcium > 3mmol/L and/or unwell - dehydrated, confusion, drowsy, coma, seizures, renal failure
Emergency management of hypercalcaemia (5)
IV access (venflon/central line)
Catheter
Rehydrate 0.9% saline (FLUIDS FLUIDS FLUIDS)
Initiate calciuresis: ).9% saline, frusemide
IV pamidronate 30-60mg (hold off)
Non emergency treatment of hypercalcaemia (3)
Keep well hydrated
Avoid thiazides
Surgery (parathyroidectomy)
What can present with depression
Hypercalcaemia
Mechanism of sarcoidosis
Systemic disease where macrophages express 1-alpha hydroxylase
CXR sarcoidosis
Bilateral hilar lymphadenopathy
PTH in sarcoidosis
Suppressed to undetectable levels
Sarcoidosis treatment
Steroids will normalise both the calcium and treat the lung problem
