hypercalcemia Flashcards
4 classic Sx of hypercal
- neuropsych (confusion/delerium) -moans
- GI - pain - groans
- renal - stones
- bones (osteoporosis)
2 treatment of hypercal
- volume expansion - iso saline
2. saline + loop - promotes Ca excretion
what is normal Ca carried as
- albumin bound - 10
2. ionized (physio active) - 5
what happens in low albumin state
albumin only carries 5, so 5:5, so need to correct if measuring total Ca
what is correctiokn for low albumin
for every 10mmol/L drop in albumin, increase Ca by 0.2
why would creatinine go up
acute renal failure from hypercalcemia
what does PTH respond to and what does it do
responds to low Ca increases 1. Renal Ca abs 2. bone resporbtiokn 3. renal hydroxylation of vit D, which increases Ca abs
where does vit D come from (2)
- diet
2. from chol by UV
2 general causes of hyper cal
- PTH indep
2. PTH dep
2 causes of high PTH
- primary hyperparathyroidism
2. familial hypercalcemic hypercalciuria
5 cause of PTH indep
- maligancy - most common
- increased intake
- drugs
- granulomatous disease
- other
3 malignant causes of hypercal
- osteolytic mets
- humoral hypercalcermia (paraneoplastic)
- Vt. D secreting
** what does normal PTH mean when CA is high
should be low, so is PTH dep hypercalcemia
why is phospate low
PTH promotes Ph excretion for Ca absorption
4 treats for hypercal
- volume expansion
- bisphophonates (days)
- glucocorticoids
- calcitonin - not really helpful
what is MOA of bisphos
lowers Ca by inhibiting release from the bone
when are glucocorticoids used
PTH indep extra renal production of calcitriol - stops production in granulomatous disease
what is treatment of last resort
dyalisis
what is needed to find hypetparathyroidism
neck imaging
3 levels of hyperpara and what will be seen
1ry - high PTH and high Ca - paraadenoma or hyperplasia
2ry - high PTH, low Ca - renal failure, vit D def., malabsorbtion
3ry - high PTH, high Ca - longstanding renal failure
2 neck imaging
- US
2. parathyroid scan - w/ substance
** indications for surgery in hyperpara
all pts with symptomoatic hypercal and asymotomitic with
- high serum Ca
- low creatinine clearance
- low bone density
- low age
what can happen when take it out
hypocalcemia
3 signs of hypocal
- chvoseck - CN7 twitch
- trousseau sign
- long QT
treatment of hypocal
mild - oral Ca
severe - Ca IV
+ ACTIVATED vit D (calcitriol) (PTH activates normally)
