Clinical Role of Ca, VitD, Exercise Flashcards Preview

Week 47: Osteoporosis > Clinical Role of Ca, VitD, Exercise > Flashcards

Flashcards in Clinical Role of Ca, VitD, Exercise Deck (12)
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1

Effects of PTH on
1. Kidney
2. Bone

1. Ca reabsorption, phosphate excretion, conversion of 25 OH vitamin D to calcitriol
2. Bone resorption with sustained high PTH, bone formation with normal episodic release

2

Cause of
1. Increased iPTH
2. Decreased or normal iPTH

1. Primary hyper PTH or familila hypercalcemic hypocalciuria
2. Malignancy

3

Hyperparathyroidism clinical picture

Increased PTH
Longstanding asymptomatic hypercalcemia or milder hypercalcemia
Postmenopausal femal
Normal physical exam
Fam hx

4

Malignancy clinical picture

Normal or decreased PTH
Higher level of serum Ca
More rapid increase in serum Ca
Therefore more symptomatic
Usually advanced disease (poor prognosis)

5

Symptoms of hypercalcemia

Stones, bones, groans and psychic moans
Mild: no symptoms, or non specific such as constipation, fatigue, depression
Longstanding: renal stones polyuria, polydipsia, osteoporosis, fractures, bone pain, anorexia, abdo pain, constipation, decreased concentration, depression
Acute or rapid rise: stupor, coma, shortened QT

6

4 causes of decreased Ca and decreased PTH

Surgical
Autoimmune
Congenital
Destruction or infiltration (rare)

7

5 causes of decreased Ca with increased PTH

Vitamin D deficiency
CKD
Sepsis or severe illness
Postsurgical, hemorrhage
Osteoblastic metastasis (uncommon)

8

Clinical manifestations of hypocalcemia (acute and chronic)

Acute: tetany, seizures
Cardio: decreased function, Qt prolongation, ventricular dysrhythmias
Chronic: dental changes, cataracts, extrapyramidal disorders

9

Hypomagnesemia

Can reduce PTH secretion of cause PTH resistance
Malabsorption, longstanding diarrhea, chronic alcoholism, severe malnutrition
Remember to check and treat Mg if hypocalcemia is present

10

When trying to determine VitaminD status, which form should you measure?

Serum 25(OH)D

11

How much Ca should you be taking?

1200 mg is sufficient (total)

12

Myostatin

Limits muscle tissue growth
If you are missing 1 or both copies you are really strong