Paulson - Calcium

Question 1

nl serum Ca

Answer 1

9-10.5

Question 2

mild hypercalcemia

Answer 2

10.5-12

Question 3

life threatening hypercalcemia

Answer 3

Ca > 14

Question 4

major causes of hypercalcemia

Answer 4

malignancy

hyperparathyroidism

Question 5

3 malignancy causes of hypercalcemia

Answer 5

ectopic secretion of pth by tumor

mm

bone mets

Question 6

endocrine and __ diseases can cause hypercalcemia

Answer 6

ganulomatous →

sarcoidosis, tb

Question 7

major class of drugs that causes hypercalcemia

Answer 7

thiazide diuretics

lithium

Question 8

what do you think when you see, milk alkali syndrome

Answer 8

hypercalcemia rt TUMS

Question 9

mc cause of hypercalcemia in hospitalized pt

Answer 9

malignancy

Question 10

mc cause of hypercalcemia in op setting

Answer 10

hyperparthyroidism

Question 11

sx of hypercalcemia

Answer 11

stones

bones

moans

thrones

abd groans

psychiatric moans

also fatigue, anxiety

Question 12

sx of severe hypercalcemia

Answer 12

lethargy

ams

sz

coma

ekg abnormalities

Question 13

4 dx steps for hypercalcemia

Answer 13

1. check serum Ca → if low
2. re-check serum Ca
3. if low → confirmed
4. measure PTH

Question 14

2 types of serology for Ca

Answer 14

ionized

total Ca

can also check urine Ca

Question 15

ionized Ca includes

Answer 15

unbound Ca

Question 16

serum Ca includes (2)

Answer 16

bound and unbound Ca

Question 17

most bound Ca is bound to

Answer 17

albumin

Question 18

if serum albumin is low, you must use

Answer 18

corrected Ca

Question 19

what type of Ca must be corrected for albumin

Answer 19

serum Ca

Question 20

after confirming hypercalcemia and checking PTH, if PTH is low you should

Answer 20

check vit D and PTHrP

Question 21

elevated PTHrP makes you think

Answer 21

malignancy

Question 22

if serum PTH is high think

Answer 22

hypercalcemia rt hyperparathyroidism

Question 23

ekg findings associated w. hypercalcemia

Answer 23

short qt interval

bradyarythmias

sinus arrest

av blocks

bundle branch blocks

Question 24

pt w. hypercalcemic crisis are usually

Answer 24

dehydrated

Question 25

tx for hpyercalcemic crisis

Answer 25

IV access → ns “wide open” until bp and perfusion normalize cardiac monitoring

Question 26

what does “wide open” ns mean

Answer 26

highest rate possible

Question 27

what is NOT recommended for tx of hypercalcemia

Answer 27

furosemide

Question 28

pharm for hypercalcemia

Answer 28

osteoclast-inhibiting

Question 29

ex of osteoclast inhibiting drugs (3)

Answer 29

bisphosphonates calcitonin glucocorticoids

Question 30

what drug is often used for hypercalcemia dt malignancy

Answer 30

bisphosphonates

Question 31

last line tx for hypercalcemia

Answer 31

dialysis

Question 32

tx for hypercalcemic crisis dt hyperprathyroidism

Answer 32

parathyroidectomy

Question 33

ekg finding for hyperCa ekg finding for hypoCa

Answer 33

hyper: short qt hypo: prolonged qt

Question 34

hypocalcemia def

Answer 34

serum Ca \< 8.5 → corrected ionized Ca \< 4.6

Question 35

3 mc causes of hypocalcemia

Answer 35

impaired pth production impaired vit D production renal dz

Question 36

what do you think when you see, hungry bones

Answer 36

hpocalcemia rt parathyroidectomy

Question 37

drugs that cause hypocalcemia

Answer 37

bishosphonates ca chealators phenytoin fluoride

Question 38

classic sx of hypocalcemia

Answer 38

trosseau sign chvostek sign

Question 39

carpal tunnel spasm after bp cuff is applied for 3 min

Answer 39

trosseau sign

Question 40

spasm of facial muscle after tapping facial n in front of ear

Answer 40

chvostek sign

Question 41

other sx of hypocalcemia

Answer 41

asymptomatic muscle spasm/cramp tetany paresthesias confusion sz dry skin, brittle nails, coarse hair anxiety, dpn, dementia

Question 42

ekg changes of hypocalcemia

Answer 42

prolonged qt or st flattening

Question 43

paresthesias rt hypocalcemia

Answer 43

perioral peripheral

Question 44

dx for hypocalcemia

Answer 44

total serum Ca → corrected for albumin vs ionized Ca serum phosphate vit D PTH check for hypomagnesium bmp

Question 45

ekg change rt hypocalcemia

Answer 45

prolonged qt

Question 46

signs of acute/severe hypocalcemia

Answer 46

ekg changes spasms other severe sx

Question 47

tx for severe hypocalcemia

Answer 47

IV calcium gluconate

Question 48

fx for mild hypocalcemia

Answer 48

op oral Ca and Vit D

Question 49

what form of Ca repletion is preferred

Answer 49

calcitriol

Question 50

most w. hypocalcemia need

Answer 50

lifelong Ca/vit D replacement

Question 51

1st step in hypocalcemia tx hypomagnesemia 1st