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SALMAN HARRISON'S > 50 - Hypercalcemia and Hypocalcemia > Flashcards

50 - Hypercalcemia and Hypocalcemia Flashcards

1
Q

In which mechanisms is calcium involved?

A
  1. Cell signaling
  2. Cardiac contractility
  3. Hormone release
  4. Coagulation
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2
Q

What are the etiological groups for hypercalcemia? (5)

A
  1. Elevated PTH
  2. PTH related peptide
  3. Granulomatous disease
  4. Primary increase in bone resorption
  5. Excessive calcium intake
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3
Q

High levels of PTH is usually due to a ___ or ____

A

Parathyroid neoplastic problem

Familial Hypocalciuric hypercalcemia (FHH)

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4
Q

PTH related peptide is secreted from ___ and acts as PTH on the ____ and the ___. In this case there will be low levels of ___

A

Solid tumors
Bone
Kidney
PTH

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5
Q

In granulomatous disease (___,___) there’s a high turnover of ___, leading to increased absorption of __ in the __, leading to ___ + hypercalcemia

A 
Sarcoidosis
Lymphoma
Vitamin D
Calcium
GI
Decreased PTH
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6
Q

___ or ___can cause increased bone turnover. ___ will be low

A

Hyperthyroidism
Lytic lesion
PTH

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7
Q

Minor hypercalcemia (___) is usually ___. symptoms may include: ___, ___, ___.

A 
11-11.5 mg/dL
Asymptomatic 
Neuropsychiatric
PUD
Nephrolithiasis
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8
Q

More severe hypercalcemia (___) may lead to ___ and even ___, alongside other ___ symptoms and ___

A 
12-13 mg/dL
Lethargy
Coma 
GI
Pancreatitis
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9
Q

Hypercalcemia damages the ability of the kidney leading to ___ and ___

A

Polydipsia

Polyuria

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10
Q

Cardiac symptoms of hypercalcemia include: (3)

A
  1. AV block
  2. Short QT
  3. Bradycardia
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11
Q

What is the first step when diagnosing hypercalcemia?

A

Make sure it is not secondary to albumin level

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12
Q

How do you calculate corrected calcium level?

A

Blood Ca+0.8(4.1-serum albumin)

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13
Q

What are the two most common causes for hypercalcemia?

A
  1. Primary hyperparathyroidism

2. Malignancy

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14
Q

Once hypercalcemia is diagnosed what should we test for?

A

PTH levels

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15
Q

High PTH usually accompanied by ___

A

Hypophosphatemia

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16
Q

What is the cause for: normal-high PTH + hypercalcemia + hypophosphatemia

A

Primary hyperparathyroidism

17
Q

What should we rule out when suspecting primary hyperparathyroidism?

A

FHH (familial hypercalciuric hypercalcemia)

18
Q

What can be ruled out as the cause for hypercalcemia when PTH is low? What will be the probable cause?

A

Parathyroid

Malignancy

19
Q

What is the treatment for minor asymptomatic hypercalcemia?

A

No treatment- look for the cause

20
Q

What is the treatment to significant hypercalcemia?

A

Immediate treatment with volume expansion

21
Q

What does volume expansion treatment for hypercalcemia include?

A

4-6 liters of NS in the first 24 hours.

22
Q

Name common drugs for hypercalcemia treatment in patients with malignancy. When do they start working?

A

Bisphosphonates
Ibandronate
Pamidronate
1-3 days

23
Q

How will you treat patients with active vitamin D dependent hypercalcemia?

A

Steroids- Hydrocortisone IV or prednisone PO

24
Q

What are the two common causes for hypocalcemia?

A

PTH synthesis problem

Vitamin D

25
Q

Low levels of PTH can be related to ___ or ___ which inhibit PTH (the opposite of ___)

A

Hypomagnesemia
CASR activating mutation
FHH

26
Q

Hypocalcemia occurs also in cases with hypoalbuminemia + hyperphosphatemia -> calcium tissue deposition-> PTH secretion issues. The main reasons for that are: (4)

A

Burns
Rhabdomyolysis
Tumor lysis
Pancreatitis

27
Q

Severe hypocalcemia clinical manifestations include:

A 
Chvostek sign
Trousseau's sign
Seizures
Bronchospasm/ Laryngospasm
Elongated QT
28
Q

What is the 1st step when diagnosing hypocalcemia?

A

Measuring calcium, albumin, phosphor, magnesium

29
Q

After taking electrolytes, what is the 2nd step when diagnosing hypocalcemia?

A

Measuring PTH

30
Q

If a patient with hypocalcemia has low PTH levels, what should you ask?

A

Reasons for destruction/damage of the parathyroid gland

31
Q

If a patient with hypocalcemia has highPTH levels, what should you ask?

A

Look for vitamin D problems (storage or renal issues)

32
Q

What is the first line treatment of hypocalcemia?

A

Calcium gluconate

33
Q

Chronic hypercalcemia secondary to hypoparathyroidism is treated with:

A

Calcium supplements + vitamin D

SALMAN HARRISON'S (163 decks)

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