Troubles du métabolisme du Ca

Question 1

Tx 1re ligne hyperCa sévère?

Answer 1

Saline infusion

hyperCa entraine déshydratation (vo +/- IR)

Question 2

Humoral hypercalcemia of malignacy is caused with parathyroid hormone related peptide (PTHrP) and can present with…?

Answer 2

hyperCa
normal of frank hypoP
Normal urine Ca

Question 3

In humoral hyperCa of malignancy, bone formation is […1], amd patients have a […2] rather than hypercloremic acidosis. Moreover, serum 1,25 dihydroxyvitamin D3 concentrations are […3] in primary hyperparaT4 and […4] in cancer.

Answer 3

1. suppressed
2. metabolic alkalosis
3. increased
4. supressed

Question 4

Dx?
hypoP
hyperCalurie?

Answer 4

HyperparaT4 primaire

Question 5

Dx ?
hyperP
hyperCa?

Answer 5

intox vit D

Question 6

Effet de la PTH sur les tubules rénaux?

Answer 6

inhibition de la réabsorption de Phosphate –> hyperphophaturie

Question 7

A patient with recurrent kidney stone and an elevated serum calcium level most likely has…?

test?

Answer 7

hyperparaT4

PTH

Question 8

Elevated PTH is caused by […] in 80% of cases (in primary hyperparaT4)

Answer 8

a single parathyroid gland adenoma

Question 9

dx hyperaraT4 primaire?

Answer 9

usually made by finding a PTH concentration that is elevated or
within the normal range but inappropriately N, given the pt’s elevated Ca level

Question 10

Effet des diurétique thiazidiques et excrétion de Ca?

Answer 10

diurétique tzd reduce Ca excretion and can cause overt sx in a pt whose hyperparaT4 would otherwise have remained asx.

Question 11

IR entraine hypo ou hyper Ca?

Answer 11

hypoCa

mais peut causer hyperCa resulting from tertiary hyperparaT4

Question 12

Déficit vit D entraine hypo ou hyper Ca?

Answer 12

hypoCa

Question 13

concentration de Ph pour avoir des sx?

Answer 13

< 0,64

rhabdomyolyse: 0,32

Question 14

Conduite pour hypoP > ou = à 0,64 ?

Answer 14

Cause sous-jacente
pas de réplétion en P

*phosphate iv = dangereux!: hypoCa, IRA, arythmies fatale…

Question 15

vrai ou faux:

hypoPh sévère est une urgence médicale

Answer 15

vrai

Question 16

Pt dénutrit +++
réalimentation per H. 
sx vague au jour 2
convulsion au jour 3.
ssx: faiblesse, confusion, dysrythmie, insuff respi, ICC, hypoTa, iléus, acidose mét, convulsion coma ad mort.

Dx? étiologie?

Answer 16

Refeeding Sd

results from decreased insulin secretion as stores of intracellular phosphate become depleted. providing carbohydrates through in fluids or refeeding increses insulin secretion, which stimulates cells to take up phosphate, causing hypophosphatemia.
in this setting cells are unable to produce enough 2,3 diphosphoglycerate and adenosine triphosphate to meet metabolic demands

Question 17

tx hyperparat4 primaire?

Answer 17

parathyroïdectomie

*rappel: hyperpara prim = adénome!