Metabolic Medicine Flashcards
What are causes of raised ALP?
Cholestasis
Paget’s disease - isolated ALP
Osteomalacia - raised ALP, low calcium+phosphate
Bone mets - raised ALP + calcium
Hyperparathyroidism - raised ALP + calcium
Renal failure - raised ALP + low calcium
Pregnancy
What are the 2 main cause of hypercalcaemia?
Primary hyperparathyroidism + Malignancy (bone mets, myeloma, squamous cell lung cancer)
What are other causes of hypercalcaemia other than the 2 main causes?
Sarcoidosis Vitamin D intoxication Acromegaly Thiazide-like diuretics Addison's disease
What ECG finding is seen in hypercalcaemia?
Short QT
How does hypercalcaemia present?
Stones, groans, bones, moans
Bone pain
Renal stones
Depression
How is hypercalcaemia treated?
IV Sodium Chloride 0.9%
What are causes of hypocalcaemia?
Vitamin D deficiency (osteomalacia) CKD Hypoparathyroidism Pseudohypoparathyroidism Magnesium deficiency Acute pancreatitis
What are signs of hypocalcaemia?
Tetany - muscle twitching/cramping/spasm
Perioral parasthaesia
Trousseau’s sign
Chvostek’s sign
What is Trousseau’s sign?
Carpal spasm if brachial artery is occluded with blood pressure cuff
What is Chvostek’s sign?
Tapping the parotid causes the facial muscles to twitch
How is hypocalcaemia managed?
10ml calcium glutinate 10% over 10 mins
What ECG changes are seen in hyperkalaemia?
Tall tented T waves
Widened QRS
Small P waves
Prolonged PR interval
What are causes of hyperkalaemia?
AKI
Addison’s disease
Rhabdomyolysis
Drugs: ACEi, ARB, Spironolactone
How is the cardiac membrane stabilised in hyperkalaemia?
IV calcium gluconate
How is hyperkalaemia treated?
IV insulin - shifts potassium back into cells
oral calcium resonium - removes potassium