HypoCa- P Flashcards
علایم هیپوکلسمی؟
1-peripheral and perioral paresthesia 2-muscle spasms 3-carpopedal spasm 4-tetany 5-laryngeal spasm 6-seizure 7-and respiratory arrest.
8-Increased intracranial pressure and papilledema may occur with long-standing hypocalcemia,
9-and other manifestations may include irritability, depression, psychosis, intestinal cramps, and chronic malabsorption.
چون‌باعث افرایش نفوذ پذیری به Na میشه و دپولاریزیشن ایجاد میشه
کاتاراکت در سن پایین : در موارد ارثی
درماتیت، اگزما، ریزش مو، موهای خشک و شکننده، شیار
رو ناخن
یبوست
يافته های W/U و P/E در هیپوکلسمی؟
Chvostek’s ( Facial muscle twitch)
and Trousseau’s signs (carpal spasm) are frequently positive: نشان دهنده تتانی
the QT interval is prolonged
Both hypomagnesemia and alkalosis lower the threshold for tetany.
اتیولوژی Hypocalcaemia Transient ?
3
Transient hypocalcemia often occurs in critically ill pts with burns,
sepsis,
and acute renal failure; following transfusion with citrated blood; or with medications such as protamine and heparin.
اثر هیپوالبومینمی بر کلسیم؟
Hypoalbuminemia can reduce serum calcium below normal, although ionized calcium levels remain normal.
The correction can be used to assess whether the serum calcium concentration is abnormal when serum proteins are low.
سطح البومین رو ۴ در نظر میگیریم، به ازای هر یک گرم کاهش البومبن به کلسیم ۰.۸ گرم اصافه میکنیم
اثر آلکالوز بر کلسیم؟
Alkalosis increases calcium binding to proteins, and in this setting direct measurements of ionized calcium should be used.
اسیدوز اتصال کلسیم به پروتییین رو کم میکنه و باعث بالا رفتن کلسیم یونیزه میشه
تقسیم بندی اتیولوژی هیپوکلسمی و‌علت هر کدوم؟
🔸PTH is absent
1-hereditary or acquired hypoparathyroidism
2-hypomagnesemia: چون در عملکرد و ترشح PTHلازم است
🔸PTH is ineffective : 1-chronic renal failure 2-vitamin D deficiency 3-anticonvulsant therapy:فنی توئین و‌کاربامزاپین 4-intestinal malabsorption 5-pseudohypoparathyroidism
🔸PTH is overwhelmed : یعنی این مقداری که هست پاسخگوی نیاز نیست
1-severe, acute hyperphosphatemia in tumor lysis
2-acute renal failure
3-or rhabdomyolysis;
4-hungry bone syndrome following parathyroidectomy
شایع ترین علت هیپوکلسمی شدید و مزمن؟ 2
The most common forms of chronic severe hypocalcemia are autoimmune hypoparathyroidism and postoperative hypoparathyroidism following neck surgery.
بیماران CKD اختلال کلسیم شون به چه صورته؟
Chronic renal insufficiency is associated with mild hypocalcemia compensated for by secondary hyperparathyroidism. The cause of hypocalcemia associated with acute pancreatitis is unclear.
درمان Symptomatic hypocalcaemia
Symptomatic hypocalcemia may be treated with IV calcium gluconate (bolus of 1–2 g IV over 10–20 min followed by infusion of 10 ampoules of 10% calcium gluconate diluted in 1 L D5
W infused at 30–100 mL/h).
درمان هایپر کلسمی مزمن؟
Management of chronic
hypocalcemia requires a high oral calcium intake, usually with vitamin D.
درمان هیپوکلسمی به دنبال هیپو پارا؟
Hypoparathyroidism requires administration of calcium (1– 3 g/d) and calcitriol (0.25–1 µg/d), adjusted according to serum calcium levels and urinary excretion.
درمان refractory hypoCa?
Restoration of magnesium stores may be required to reverse hypocalcemia in the setting of severe hypomagnesemia.
PTH (1-84) (Natpara) has been approved for the treatment of refractory hypoparathyroidism, representing an important advance in treatment of these pts.
علایم Hypophosphataemia
🍓Mild hypophosphatemia is not usually associated with clinical symptoms.
🍓In severe hypophosphatemia, pts may have muscle weakness, numbness, paresthesia, and confusion.
🍓Rhabdomyolysis may develop during rapidly progressive hypophosphatemia.
🍓Respiratory insufficiency can result from diaphragm muscle weakness.
اتیولوژی هیپوفسفاتمی؟ 4
🍇decreased intestinal absorption:
1-vitamin D deficiency
2-phosphorus-binding antacids
3-malabsorption
🍇urinary losses: 1-hyperparathyroidism 2-hyperglycemic states 3-X-linked hypophosphatemic rickets 4-oncogenic osteomalacia 5-alcoholism 6-certain toxins
🍇shifts of phosphorus from extracellular to intracellular compartments :
1-administration of insulin in diabetic ketoacidosis
2-by hyperalimentation or refeeding in a malnourished pt
🍇In syndromes of severe primary renal phosphate wasting
1-X-linked hypophosphatemic rickets,
2-autosomal dominant hypophosphatemic
rickets, oncogenic osteomalacia), the phosphatonin hormone FGF23 (fibroblast plays a key pathogenetic role.
درمان هیپوفسفاتمی mild?
Mild hypophosphatemia can be replaced orally with milk, carbonated beverages, or Neutra-Phos or K-Phos (up to 2 g/d in divided doses).
درمان هیپوفسفاتمی severe?
For severe hypophosphatemia (0.75 mmol/L; [<2.0 mg/dL]), IV phosphate may be administered
at initial doses of 0.2–0.8 mmol/kg of elemental phosphorus over 6 h.
The total body phosphate depletion cannot be predicted from the serum phosphate level;
careful monitoring of therapy is therefore required. Hypocalcemia should be corrected first, and the dose reduced 50% in hypercalcemia.
Serum calcium and phosphate levels should be measured every 6–12 h; a serum calcium × phosphate product of >50 must be avoided.
تعریف هایپر فسفاتمی؟
In adults, hyperphosphatemia is defined as a level >1.8 mmol/L (>5.5 mg/dL).
اتیولوژی هایپر فسفاتمی؟ 7
The most common causes are acute and chronic renal failure, but it may also be seen 2-in hypoparathyroidism, 3-vitamin D intoxication, 4-acromegaly, 5-acidosis, 6-rhabdomyolysis, 7-and hemolysis.
Hyperphosphatemia in chronic kidney disease
lowers blood calcium levels by several mechanisms, including extraosseous
deposition of calcium and phosphate, impairment of the bone-resorbing action
of PTH, and reduction in 1,25(OH)2
D production due to elevated FGF23 and
diminished renal tissue.
پیامد های کلینیکال هایپرفسفاتمی؟
The clinical consequences of severe hyperphosphatemia
are hypocalcemia and calcium phosphate deposition in tissues.
Depending on the location of tissue calcifications, serious chronic or acute complications may ensue (e.g., nephrocalcinosis, cardiac arrhythmias).
درمان هایپرفسفاتمی؟
Therapy consists of treating
the underlying disorder and limiting dietary phosphorus intake and absorption.
Oral aluminum phosphate binders or sevelamer may be used, and hemodialysis
should be considered in severe cases.
علایم هیپومگنزمیا؟
کوموربیدیتی؟
Hypomagnesemia usually indicates significant whole body magnesium depletion.
Muscle weakness, prolonged PR and QT intervals, and cardiac arrhythmias
are the most common manifestations of hypomagnesemia.
Magnesium is important for effective PTH secretion as well as the renal and skeletal responsiveness to PTH.
Therefore, hypomagnesemia is often associated with hypocalcemia.
اتیولوژی Hypomagnesaemia
Hypomagnesemia generally results from a derangement in renal or intestinal
handling of magnesium and is classified as primary (hereditary) or Secondary (acquired).
