hypercalcaemia and acute uremia Flashcards
what is the normal albumin correctedd serum calcium level ?
8-10 mg/dl
equivalent to
2-2.5 mmol/l
most common cause of hypercalcemia in hospitalized patients ?
malignancy
how is the corrected calcium level calculated ?
0.8 x ( normal albumin level - patients albumin level ) + serum calcium level
what is the normal albumin level ?
4 mg/dl
3 main broad reasons for hypercalcemia ?
gastrointestinal absorption
renal tubular reabsorption of calcium
increased bone resorption
what are the levels of hypercalcaemia ?
mild: 10-12 mg/dl
moderate: 12-14 mg/dl symptoms start from here
severe: more than 14 mg/dl
clinical manifeestations of hypercalcaemia ?
stones : nephrolithiasis
bones : bone pain
groans : abdominal pain , myalgia , arthralgia
psychic overtones : confusion, anxiety, depression
most common cause of hypercalcemia in patients with non metastatic solid tumors and NHL ?
tumor secretion of parathyroid hormone
what are the other 2 mechanisms associated with hypercalcemia?
osteolytic metastasis with local release of cytokines
tumor production of 1,25-dihydroxyvitamin D (calcitriol)
what is the other term used to refer to thee mechanism of parathyroid hormone release by tumors ?
humoral hypercalcemia of malignancy
what are the typical lab findings in HHM ?
increased s.PTHrP
very low or suppressed serum intact PTH
normal to low serum 1,25-dihydroxyvitamin D
what are the typical findings in patients with osteolytic metastases ?
low or suppressed PTH
Low or normal PTHrP
Low or normal serum 1,25 vit d
what is the most common cause of hypercalcemia in lymphomas ?
1,25 dihydroxyvitamin D production
acting by increasing intestinal absorption of calcium
patient presents with hypercalcemia and is given glucocorticoids and responds well to it - what was the most likely mechanism of hypercalcemia ?
1,25 dihydroxyvitamin D production
what is the role of FGF23 in hypercalcaemia ?
FGF23 inhibits renal phosphate reabsorption
increasing the conservation of calcium
what drugs are associated with hypercalcemia ?
lithium
calcium supp
thiazide and diuretics
initial and first line of treatment of hypercalcemia ?
hydration with crystalloid IV fluid
patients with overall fluid overload - use a loop diuretic
type of biphosphonate used to inhibit bone resorption ?
zoledronate
what is thee management for hypercalcemia that is refractory to ZA ?
denosumab
or if the patient is allergic or has renal failure , denosumab can be used
what is the second line treatment for hypercalcemia ?
calcitonin
when should dialysis be considered ?
when hypercalcemia is accompanied by renal failure
classification of urological obstruction?
low - obstruction at the level of the urethra prostate or bladder
high
what are the symptoms associated with high UO vs low UO ?
high UO - presents with signs of uraemia
low UO - presents with signs of inability to urinate , or incontinence due to overflow of a full bladder
what is the treatment for upper vs lower UO?
with high UO : if the cause is not reversible in the short term or if there is signs of severe renal failure - diveersion of the urinary tract is indicated
with Low UO : urinary foley catheter placement or a suprapubic tube if there is a tight urethral stricture
how is a diagnosis of upper UO made ?
ultrasound first
followed by CT without contrast or MRI
how is a diagnosis of Low UO made ?
suprapubic tenderness
ultrasound used to confirm the diagnosis if not clinically clear
what are the two types of cystitis associated with cancer patients ?
radiation induced cystitis
chemotherapy induced cystitis
what typee of raddiotherapy is associateedd withh RIC ?
EBRT / brachytherapy for pelvic neoplasms
what are the different stages of damage associated with RIC ?
acute - 4 to 6 weeks
chronic - 6 months to 1 year
late - up to 10 years
after RTH
what is the presentation of RIC ?
haematuria
burning
frequency
urgency
incontinence
what is important to consider when confirming a diagnosis of RIC ?
based on clinical suspicion
confirmed through cystoscopy when needed
urine culture and cytology recommended to rule out other causes
what is the treatment for RIC ?
placement of a urinary catheter with irrigation until the elimination of clots followed by normal saline bladder irrigation
what chemotherapeutic agent causes cystitis ?
cyclophosphamide , due to acrolein
what is the treatment for CIC ?
prevention is critical ass this is a preventable type
to prevent : vigorous IV hydration to reduce urine concentration of acrolein along with administration of MESNA to detoxify the acrolein
clinical definition of acute renal failure ?
sudden decrease in GFR with an acute rise in blood urea nitrogen
and serum creatinine levels
post renal failure cause ?
TLS
characterised by hypercalcemia , hyperuricemia , hyperphosphatemia and hyperkalemia
most common cause of pre renal failure ?
hypoperfusion
what are the available methods for urinary diversion in upper UO ?
- 1) Placement of percutaneous nephrostomy tubes
- 2) Addition of indwelling ureteral stents through cystoscopy
- Devices need to be changed every 3– 6 months
