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Flashcards in Calcium Deck (16):
1

Hypercalcemia

Ca > 11 mg/dL

Constipation
Fatigue
Depression
Muscle weakness
Coma
Changes in sensorium

WISHbone

Williams syndrome
Ingestion (vit A and D, thiazides)
Skeletal (dysplasias, immobilization/body cast)
Hyperparathyroidism

2

Hypercalcemia treatment

Fluid
Furosemide
EKG monitoring

Calcitonin in rare cases

3

Hypocalcemia

Ionized Ca < 4.5 mg/dL (1 mmol/L)
+ total Ca < 8.5 mg/dL

Painful muscle spasms
Seizures, esp. resistant to diazepam
Vomiting
Prolonged QT

Chvostek sign: tap anterior to earlobe and below cheek bone --> mm. contraction on that side
Trousseau sign: inflate BP cuff >SBP and leave it for 2 min --> carpal mm. spasm on that side
Hypomagnesemia

PINK (causes)

Pseudohypoparathyroidism
Intake deficiency, immune deficiency (DiGeorge)
Nephrotic syndrome (low albumin --> low Ca)
Kidney insufficiency

Tx: calcium

4

Vitamin D deficiency

Hypocalcemia
Hypophosphatemia

5

Hypoparathyroidism

Hypocalcemia
Hyperphosphatemia

6

Hyperparathyroidism

Hypercalcemia
Hypophosphatemia

7

Pseudohypoparathyroidism

Hypocalcemia
High PTH

Organs are resistant to PTH

Developmental delay
Short
Obese
Moon facies
Calcification of basal ganglia

8

When do u need emergent Ca?

Hypocalcemia
Hyperkalemia
Calcium channel blocker ingestion
Hypermagnesemia

9

Rickets

what are the two types of rickets?

Deficient mineralization of bone at growth plate
-so only occurs before growth plates close


Calcipenic rickets: Ca issue

Phosphopenic rickets: phosphate issue

All types of rickets have elevated alkaline phosphatase

10

Osteomalacia

Deficient mineralization of bone at the bone matrix

11

Rickets presentation

Bone pain
Anorexia
Decreased growth rate
Widened wrists and knees
Delayed teeth eruption, bad tooth enamel
Bowed legs
Rachitic rosary: enlarged costochondral junctions, "pigeon chest"
Craniotabes: softening skull, delayed suture and fontanelle closure, frontal bossing

Kid may be on anti-convulsants
Can occur with liver disease (decreased bile salts --> decreased vitamin D absorption)

12

Calcipenic rickets

Not enough Ca to meet needs of growing bone
-Ca could be normal or low
-phos can sometimes be normal

High PTH always
Bone phoning home for more calcium!

3 types
1. Vitamin D deficient rickets
2. Vitamin D dependent rickets type 1
3. Hereditary vitamin D resistant rickets (vitamin D dependent rickets type 2)

13

Vitamin D deficient rickets

Most common type of rickets
Nutritional

-Breast-feeding without vitamin D supplement
-Little sunlight exposure, dark skinned, born in fall/winter
-Low birth weight, premature, or both
-Infant on strict vegan diet excluding dairy.
-Infant can be born with congenital rickets if mother on a strict nondairy diet
-lactose intolerant kids

Low 25-hydroxy vitamin D

Tx: vitamin D and Ca supplements

14

Vitamin D dependent rickets type 1

Autosomal recessive
Inadequate kidney production of 1,25 – dihydroxy vitamin D (the active metabolite)

Liver is ok, so it is still making 25-hydroxy vitamin D (step 1)

Aka pseudo-vitamin D resistant rickets

Tx: vitamin D2 and 1,25-hydroxy vitamin D

15

Hereditary vitamin D resistant rickets

Aka vitamin D dependent rickets type 2

Autosomal recessive

End organ resistance to vitamin D

Elevated 1,25-dihydroxy vitamin D

16

Phosphopenic rickets

Low phosphate
Ca and PTH may be normal

Usually due to renal phosphate wasting

X-linked hypophosphatemic rickets
-X-linked dominant
-MC in industrialized countries
-too much phosphate lost via kidneys
-Tx: phosphate, 1,25-dihydroxy vitamin D