hypercalcemia

Question 1

4 classic Sx of hypercal

Answer 1

1. neuropsych (confusion/delerium) -moans
2. GI - pain - groans
3. renal - stones
4. bones (osteoporosis)

Question 2

2 treatment of hypercal

Answer 2

1. volume expansion - iso saline

2. saline + loop - promotes Ca excretion

Question 3

what is normal Ca carried as

Answer 3

1. albumin bound - 10

2. ionized (physio active) - 5

Question 4

what happens in low albumin state

Answer 4

albumin only carries 5, so 5:5, so need to correct if measuring total Ca

Question 5

what is correctiokn for low albumin

Answer 5

for every 10mmol/L drop in albumin, increase Ca by 0.2

Question 6

why would creatinine go up

Answer 6

acute renal failure from hypercalcemia

Question 7

what does PTH respond to and what does it do

Answer 7

responds to low Ca
increases
1. Renal Ca abs
2. bone resporbtiokn
3. renal hydroxylation of vit D, which increases Ca abs

Question 8

where does vit D come from (2)

Answer 8

1. diet

2. from chol by UV

Question 9

2 general causes of hyper cal

Answer 9

1. PTH indep

2. PTH dep

Question 10

2 causes of high PTH

Answer 10

1. primary hyperparathyroidism

2. familial hypercalcemic hypercalciuria

Question 11

5 cause of PTH indep

Answer 11

1. maligancy - most common
2. increased intake
3. drugs
4. granulomatous disease
5. other

Question 12

3 malignant causes of hypercal

Answer 12

1. osteolytic mets
2. humoral hypercalcermia (paraneoplastic)
3. Vt. D secreting

Question 13

** what does normal PTH mean when CA is high

Answer 13

should be low, so is PTH dep hypercalcemia

Question 14

why is phospate low

Answer 14

PTH promotes Ph excretion for Ca absorption

Question 15

4 treats for hypercal

Answer 15

1. volume expansion
2. bisphophonates (days)
3. glucocorticoids
4. calcitonin - not really helpful

Question 16

what is MOA of bisphos

Answer 16

lowers Ca by inhibiting release from the bone

Question 17

when are glucocorticoids used

Answer 17

PTH indep extra renal production of calcitriol - stops production in granulomatous disease

Question 18

what is treatment of last resort

Answer 18

dyalisis

Question 19

what is needed to find hypetparathyroidism

Answer 19

neck imaging

Question 20

3 levels of hyperpara and what will be seen

Answer 20

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

Question 21

2 neck imaging

Answer 21

1. US

2. parathyroid scan - w/ substance

Question 22

** indications for surgery in hyperpara

Answer 22

all pts with symptomoatic hypercal and asymotomitic with

1. high serum Ca
2. low creatinine clearance
3. low bone density
4. low age

Question 23

what can happen when take it out

Answer 23

hypocalcemia

Question 24

3 signs of hypocal

Answer 24

1. chvoseck - CN7 twitch
2. trousseau sign
3. long QT

Question 25

treatment of hypocal

Answer 25

mild - oral Ca
severe - Ca IV
+ ACTIVATED vit D (calcitriol) (PTH activates normally)