Parathyroid Flashcards
If patient presents with high calcium, what is the next step in evaluating the patient?
Check a renal function and PTH level
If the PTH level is high when it comes back, what is you working diagnosis?
Hyperparathyroidism
If the calcium and phosphate levels are moving in opposite directions, what kind of issue do we have? What if they are moving in the same directions, what kind of issue do we have?
PTH issue
Vitamin D issue
What if the PTH came back low, what are we thinking?
Something producing PTHrP or calcium, so malignancy granulomatous disease, lymphoma
What symptoms are associated with rapid increase in calcium?
Dehydration and renal issues
What if the increase in calcium is more gradual, what 3 problems are we thinking?
Kidney stones, bone problems, mental problems
What medication would you use for high calcium and hypertension and why? What med would you not use and why?
Loop diuretic because it will get rid of the fluid and calcium
Don’t use thiazides because they will bring calcium back in
So, treating chronic hypercalcemia, we would use?
Loops
What is your stored vitamin d marker and active vitamin d marker?
25 OH is storage
1,25 is active
What are the three ways we find calcium in the body?
50% is ionized or free
10% is bound to anions
40% is bound to protein, albumin being the most common
What is the formula to correct calcium level for low albumin?
Measured calcium + .8(4 - serum albumin) = corrected calcium
What is the range for mild hypocalcemia? Moderate? Severe?
8-8.4
7.5-8
Below 7.5
What does laying down and rest do to calcium and why?
It increases it because being immobilized increases osteoclast activity
Explain the importance of kidney functions to calcium levels? 2 things?
Number one, we need kidneys to convert 25 oh to active 1,25.
Number 2, we need kidneys to kick out phosphate and bring in calcium.
What does PTH have to do with vitamin D?
One of the many roles of PTH is to encourage conversion of 25 to 1,25 but we need the kidneys to do this.
Peripheral dexa vs. central dexa?
Peripheral is used for screening of bone density only.
Central is checking lower spine and hips because you have a suspicion of osteoporosis
What is the recommended supplement for low calcium?
Calcium carbonate
What if the patient is on a med to lower stomach acid, what do you give for low calcium?
Calcium citrate
Patient presents with super high calcium and EKG shows super short QT, what do we give to treat in the hospital?
Fluids to flush the calcium out and consider a loop.
