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Lecture Notes - Endocrinology > Hypocalcaemia > Flashcards

Hypocalcaemia Flashcards

1
Q

What causes hypocalcaemia

A

decreased calcium entry into the circulation or increased loss of free calcium from the circulator

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2
Q

What are some causes of decreased calcium entry into the circulation

A

Vitamin D deficiency
Hypoparathyroidism
pseudohypoparathyroidism

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3
Q

What are some causes of extravascular calcium deposition

A

Rhabdomyolysis and tumour lysis syndrome
Acute pancreatitis
Widespread osteoblastic metastases
Hungry bone syndrome

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4
Q

What are some causes of increased intravascular calcium binding

A

acute respiratory alkalosis
Massive blood transfusion
Foscarnet

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5
Q

What can be associated with hypocalcaemia due to impaired secretion of both PTH and calcitrol

A

Sepsis

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6
Q

What are some causes of vitamin D deficiency

A

lack of sun exposure
poor intake or malabsorption (coeliac disease)
Liver failure
Chronic kidney disease
Impaired activation of Vitamin D due to mutations in the 1alpha - hydrolyse gene
Target organ resistance due to mutations in the vitamin D receptor gene

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7
Q

What are some causes of hypoparathyroidism

A 
post thyroid or parathyroid surgery 
autoimmune 
Infiltrative disease of the parathyroid glands: Wilson'd, haemochromatosis 
Congenital: DiGeorge syndrome 
Hypomagensaemia
HIV infection
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8
Q

What MSK problems could be a sign of hypocalcaemia

A

Tetany
muscle spasms/ cramps
paraesthesia
myopathy
Ckvostek’s sign (tapping the facial nerve in front of the ear causes contraction of the facial muscles ipsilaterally)
Trousseau’s sign: inflating the blood pressure cuff to above systolic BP causes carpal spasm

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9
Q

What are some neuropsychiatric / eye problems that could be a sign of hypocalcaemia

A

Seizures, fatigue, depression, anxiety
movement disorders: dystonia, hemiballismus, basal ganglia calcifications
Eyes: cataracts, papilloedema with severe hypocalcaemia

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10
Q

What are some cardiac signs of hypocalcaemia

A

Cardiac failure
hypotension
prolonged QT interval
decreased digoxin effect

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11
Q

What are some GI symptoms of hypocalcaemia

A

Reduced gastric acid secretion

steatorrhoea

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12
Q

What are some skin symptoms of hypocalcaemia

A

Dry and coarse skin and hair

brittle nails

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13
Q

What is pseudohypoparathyroidism characterised by

A

PTH resistance usually caused by mutations in the GNAS gene) resulting in an inability of PTH to activate adenylate cyclase

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14
Q

Describe some phenotypic characteristics of type 1a disease (maternal)

A 
short stature
obesity 
round face 
short fourth/ fifth metacarpals 
subcutaneous calcification 
occasionally mental retardation

they also have hypocalcaemia

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15
Q

Describe the difference between maternally inherited and paternally inherited mutations in type 1a

A

Paternally have the same phenotypic abnormalities but have normal serum calcium levels

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16
Q

What is type 1b pseudohypoparathyroidism characterised by

A

hpocalcaemia but not the phenotypic abnormalities

17
Q

What makes up Albright’s hereditary osteodystrophy (AHO)

A

short stature
obesity
round face
short fourth and fifth metacarpals

18
Q

What are some useful tests in determining the cause of hypocalcaemia

A 
serum phosphate
magnesium
alkaline phosphatase
creatinine
alanine transaminase 
coeliac screen 
intact PTH
19
Q

Describe the levels of phosphate and PTH in hypoparathyroidism

A

Phosphate levels may be normal or high

PTH is low

20
Q

Describe the levels of the following in vitamin D deficiency serum phosphate
urinary calcium exceretion
bone specific alkaline phosphatase
PTH

A

serum phosphate: low or normal
urinary calcium exceretion : low
bone specific alkaline phosphatase: elevated
PTH: raised

21
Q

What is the treatment for patients with an adjusted total calcium of more than 1.9mmol/L

A

usually asymptomatic but can be treated by increasing dietary calcium intake

22
Q

What should be given for patients with tetany, seizures, ECG changes and reduced cardiac function

A

IV calcium

23
Q

Why is calcium gluconate preferred over calcium chloride

A

it causes less local tissue necrosis

24
Q

How is calcium gluconate given

A

10ml 10% infused over 10-20 minutes with cardiac monitoring

25
Q

How should concomitant hypomagnesaemia be corrected

A

with IV magnesium sulphate

26
Q

What is the preferred preparation of Vitamin D for patients with severe acute hypocalcaemia and why

A

Calcitriol

It has a rapid onset of action

27
Q

What should the total serum calcium measurement always be adjusted for

A

albumin levels

28
Q

What is the ultimate goal of treatment in chronic hypocalcaemia

A

Maintain serum calcium in the low-normal range without causing hypercalciuria

Lecture Notes - Endocrinology (40 decks)

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