hyperCa, hypoNa Flashcards
hypercalcemia with high PTH
adenoma; hyperplasia; carcinoma
lithium
FHH
PTH r tumor
PTH LOW under 25 and hypercalcemia
PTH r peptide - ca lung / renal MTS bones MM Vit D1/25 -- granulomatous dx sarcoid; histo, silicosis Vit D 25 granulomatous hyperthyroidism milk alkali sy hctz vit A Immobilization
Ca 10, PTH 50
This is still primary hyperPTH / PTH should be suppressed/
which medication can mimick hyperPTH
Lithium
PTH 325 Ca level 10
elderly frail; likely lack of vit D 0H25
Tertiary hyperparathyroidism
ESRD with poor phosphorus binder compliance
HIGH CALCIUM LOW PTH, HIGH1/22 VIT D DX
SARCOID
WEIGHT LOST; LOW PTH, HIGH CA;
DIARRHEA
CHECK THYROID - HYPERTHYROIDISM
low urine calcium; mild elevated calcium; PTH wnl, vit D wnl.; healthy person
FHCC
TREATMENT OF HYPOCALCEMIA IN RHABDO?
released P is binded by calcium –> low calcium; do not replace as rhabdo stop you would have hypercalcemia
vitamin D mediated hypercalcemia examples
sarcoid
any granulomatous disease
Lympho
Good paster
jaundice and hyperalcemia
suspect vitamin A OD
jaundice without eyes icterus
vitamin A
check for calcium
confusion calcium 12 PTH low D1/25 LOW high vitamin D 25OH over 150
HYPERVITAMINOSIS D
STORAGE TIME LONG
TRY STEROIDS
which mechanism is MM causing hypercalceia
lytic release from bones
high vitamin D low PTH low vitamin D 25OH, low vitamin D 1/25 total protein elevated
MM
hypercalcemia with NL PTH
low vitamin D 1,25 and d25
mild elevated kappa chain in urin
ddx MGUS - with primary hyper PTH / PTH should be in this case suppressed /
MM would be much higher
silicon implants and electrolyte abnormalities
hypercalcemia due to granulomatous mechanism
high D1/25
low pth
low D25OH
LEAKING SILICON - GRANULOMAS - MACROPHAGES CONVERTING 250H D TO 1-25D
first two steps evaluation of hyponatremia
serum osmolarity
urine osmolarity
true hyponatremia serum osmolarity
below 275
second step to eval hyponatremia
urine osmolarity
urine osmolarity over 100
urine omsolarity below 100
> 100 - ADH activated