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Calcium Aetiology and Mx
PT glands behind thyroid
PTH released by dishinibition of Ca receptors
PTH acts on gut indirectly via Vit D- 1,25 which tells gut to reabsorb Calciuma and phosphate (1 alpha hydroxylase)
kidney resabsorbs calcium and extrets phosphate
Clasts breakdown bony matrix releasing calcium and phosphate
Albumin
only 1% free (as ionised calcium)
every one change in albumin = a change in the opposite diection of calcium (from normal)
Hypocalcaemia Management
Check if symptoms
Trousseau = capal pedal spasm on cuff inflation
Chvostek = Tapping (no dulling of reflex)
Prolinged QT interval on ECG
Hypercalcaemia Mx
‘bones, stones, groans and psychic moans’
corneal calcification
shortened QT interval on ECG
hypertension
Increased risk of pseudogout
Moans = AMS
Groans = abdo pain
Sx then tx straight away with IVF (solution to polution is dilution) and Bisphosphonates
Calcitonin (calcium turn down) if severe
Can add loop directics (block calcium reabsorption) when volume resiscitated (or it could make it worse)
Hypercalcaemia Diagnosis
Hyperthyroidism MC
Primary - One hyperfunctioning
Tertiary = all Hyperfunctioning
Secondary = Appropriate response to relative hypocalcaemia in early kidney disese GIVE CINACELCET (calcium mimicker) to prevent tertiary
IX
Differentiate with Sestamibi Scan (technetium-MIBI subtraction scan)
Xray may show pepperpot skull
High calcium and as kidney is functioning it wins
brown tumours = unique to parathyroidism (not really malignancy by eat away at bone)
Tx with resection but watch out fo hypocalcaemia as remainiong PT glands atrophied as suppressed
calcimimmet compounds if unsuitable for surgery
Hypercalcaemia of cancer
Ca inhibits PT release therefore kidneys do not win
PT related protein acts on kidney so Kidney wins
differentiate with phosphate
Hypervitaminosis D
Can see with ingesting in practice
Granulomatous disease increase completed 1,25 vit D produciton so kidneys absorb more calcium an phosphate so
TB and Sarcoid presentation
Hypercalcaemia of immobility = rare, ASx ,old person, trauma, immobility with hypercalcaemia
Familial Hypecalcaemic hypocalcinuria = benign
First ones = big derangements and last = small derangements
Thiazide diuretics can cause hypercalcaemia
Bone Mets Cause
MC source: Prostate>breast>lung
MC site: Spine>Pelvis>Ribs>Skull>Long bones
