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Flashcards in hypercalcemia Deck (25):
1

4 classic Sx of hypercal

1. neuropsych (confusion/delerium) -moans
2. GI - pain - groans
3. renal - stones
4. bones (osteoporosis)

2

2 treatment of hypercal

1. volume expansion - iso saline
2. saline + loop - promotes Ca excretion

3

what is normal Ca carried as

1. albumin bound - 10
2. ionized (physio active) - 5

4

what happens in low albumin state

albumin only carries 5, so 5:5, so need to correct if measuring total Ca

5

what is correctiokn for low albumin

for every 10mmol/L drop in albumin, increase Ca by 0.2

6

why would creatinine go up

acute renal failure from hypercalcemia

7

what does PTH respond to and what does it do

responds to low Ca
increases
1. Renal Ca abs
2. bone resporbtiokn
3. renal hydroxylation of vit D, which increases Ca abs

8

where does vit D come from (2)

1. diet
2. from chol by UV

9

2 general causes of hyper cal

1. PTH indep
2. PTH dep

10

2 causes of high PTH

1. primary hyperparathyroidism
2. familial hypercalcemic hypercalciuria

11

5 cause of PTH indep

1. maligancy - most common
2. increased intake
3. drugs
4. granulomatous disease
5. other

12

3 malignant causes of hypercal

1. osteolytic mets
2. humoral hypercalcermia (paraneoplastic)
3. Vt. D secreting

13

** what does normal PTH mean when CA is high

should be low, so is PTH dep hypercalcemia

14

why is phospate low

PTH promotes Ph excretion for Ca absorption

15

4 treats for hypercal

1. volume expansion
2. bisphophonates (days)
3. glucocorticoids
4. calcitonin - not really helpful

16

what is MOA of bisphos

lowers Ca by inhibiting release from the bone

17

when are glucocorticoids used

PTH indep extra renal production of calcitriol - stops production in granulomatous disease

18

what is treatment of last resort

dyalisis

19

what is needed to find hypetparathyroidism

neck imaging

20

3 levels of hyperpara and what will be seen

1ry - high PTH and high Ca - paraadenoma or hyperplasia
2ry - high PTH, low Ca - renal failure, vit D def., malabsorbtion
3ry - high PTH, high Ca - longstanding renal failure

21

2 neck imaging

1. US
2. parathyroid scan - w/ substance

22

** indications for surgery in hyperpara

all pts with symptomoatic hypercal and asymotomitic with
1. high serum Ca
2. low creatinine clearance
3. low bone density
4. low age

23

what can happen when take it out

hypocalcemia

24

3 signs of hypocal

1. chvoseck - CN7 twitch
2. trousseau sign
3. long QT

25

treatment of hypocal

mild - oral Ca
severe - Ca IV
+ ACTIVATED vit D (calcitriol) (PTH activates normally)

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