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Session 2 CM endo4

CM- Endo -4- Parathroids/Calcium lect 9-12

Where does the inferior parathyroid gland develop from embryologically the third pharyngeal pouch
Where does the superior parathyroid gland develop from embryologically develops from the fourth pharyngeal pouch along with the thyroid gland
How do the parathyoid glands normally look, how big are they, how much do they weigh typically ovoid in shape, yellow-tan colored and measure 5mm x 3mm x 1mm and weight on average 35mg glands are soft in texture and highly vascular
Where do you typically find the superior parathyroid glands they are typically found close to and often within the capsule of the superior pole of the thyroid gland -lie approx 1 cm above the junction of the inferior thyroid artery and recurrent laryngeal nerve at the level of the cricoid cartilage
Where do you typically find the inferior parathyroid glands commonly located on the posterior lateral aspect of the lower thyroid gland pole. -lie below the junction of the inferior thyroid artery and anterior to the recurrent laryngeal nerve
What arteries supply the parathyroid glands superior thyroid artery, inferior thyroid artery
what veins supply the parathyroid glands superior thyroid vein, middle thyroid vein, inferior thyroid vein.
What nerve supplies the parathyroid gland middle cervical ganglion, inferior cervical ganglion
What is the job of chief cells in the parathyroid and how do they appear microscopically chief cells manufacture PTH -stain darker, smaller and are many in number
What is the job of Oxyphil cells of the Parathyroid and how do they appear microscopically function is unknown, stain lighter, larger and are few in number
What is the main function of the parathyroid gland maintain normal calcium homeostasis between 8.5- 10.2 mg/dl
What is the normal range of [Ca++] 8.5 to 10.2 mg/dl
How does the parathyroid manage calcium levels senses changes in ambient levels of extracellular calcium and respond by secreting PTH (parathyroid hormone)
What does PTH (parathyroid hormone) do increases calcium resorption from the bone and kidney
What does a rise in serum calcium do to PTH secretion a rise in serum calcium concentration acts as a negative feedback loop and reduces PTH secretion
Where can we get calcium from and how is it eliminated from the body calcium can be absorbed from the diet or resorbed from the bone. Excess is excreted by kidney
HOw much calcium intake does a young adult require, and how much does a child need young adult needs 12-15 mg/kg/day a child needs double to triple the adult requirements during growth spurts
Why do adults over 50 need more dietary calcium they have a decrease in intestinal calcium absorption
How much of the calcium ingested is actually absorbed, where is it abosrbed only 20-30% of calcium ingested is actually absorbed into ECF, Primarily absorbed in the small intestine
What compound helps in absorption of dietary calcium and phosphorus 25-OH vit. D
Does the kidney excrete a lot of calcium NO. Kidney is very efficient at resorption of excreted calcium only a small amount is excreted unless hypercalcemia is present
Where is the majority of the calcium in the body found 98% stored in the skeleton as hydroxyapatite
Of plasma calcium what is the only biologically active form of calcium ionized calcium is the biologically active form of Calcium
What can protein bound calcium aid in can dissociate from carrier to defend against low serum levels of Calcium (hypocalcemia)
What plasma proteins bind calcium albumin 80% Gobulin 20%
What will you see in total calcium vs ionized calcium in low protein states in low protein states total calcium will be decreased but ionized calcium will not
What can cause low protein states effecting total calcium readings Cirrhosis or nephrosis
What is the formula to correct calcium in low protein states (4 - measured albumin)x(0.8)+(measured calcium)
Where do we get Vit D3 made via photogenesis in the skin and absorbed in dietary intake
Is Vit D3 biologically active NO it must by hydroxylated by liver to form 25-OH Vit D (calcidiol)
What does 25-OH Vit D do aids in absorption of calcium and phosphorus in the small intestines
What do the renal tubules do to Vit D3 hydroxylate 25-OH Vit D to 1,25-OH Vit D (calcitriol)
HOw are Vit D metabolites eliminated from the body Excreted primarily in bile
How does PTH keep serum calcium from falling below physiological concentrations stimulates calcium movement from intestinal and renal tubular lumen and from bone fluid compartment into the blood
What does PTH do to phosphate level keeps phosphate from rising above normal physiological level by increasing tubular excretion of phosphate
HOw does PTH act on bone Directly activates osteoclasts stimulating bone resorption.
What effect does PTH have on kidney directly causes increased resoprtion of calcium increases excretion of phosphorous increase conversion of 25-OH-D3 to 1,25-OH-D3 (calcitriol)
Does Direct effect does PTH have on GI No direct effect on GI tract renal conversion of 25-OH-D3 to 1,25-OH-D3 by PTH indirectly provides the stimulus to increase calcium and phosphorus absorption in the intestines
What is secreted by the thyroid in response to hypercalcemia and which cell secrete it Calcitonin secreted by Parafollicular cells (C-cells)
What does Calcitonin do prevents increase in serum calcium and phosphorus (PTH antagonist) -Decreases renal absorption of calcium -decreases release of calcium and phosphorus from bone -No effect on intestinal absorption of calcium
What does Calcitonin do to Intestinal absorption of calcium no effect on intestinal absorption of calcium
What effect does PTH have on Bone Kidney Intestine Bone- ↑ Ca+ and ↑ Phosphorous Kidney- ↑ Ca+ but ↓Phos ↑1,25 OH D3(calcitriol) intestine- No direct effect
What effect does Vit D have on bone kidney intestine Bone- NO effect Kidney- ↓ Ca+ Intestine- ↑Ca+, ↑Phos
What effect does Calcitonin have on bone kidney intestine Bone-↓Ca+ resorption, ↓Phos resorption Kidney-↓Ca+ resorption, ↓Phos resorption Intestine- No direct effect
What effect does Thyroid T4 have on bone kidney intestine Bone- ↑Ca+ Kidney- Intestine- ↓Ca+, ↓Phos
What effect does Glucocorticoid have on bone kidney intestine bone- ↑Ca+ kidney-↓Ca+ intestine-↓Ca+
What effect does Insulin and Furosemide have on bone kidney intestine bone kidney- ↓Ca+ Intestine-
What effect does Thiazide have on bone kidney intestine bone- Kidney- ↑Ca+ Intestine-
What effect does metabolic acidosis have on bone kidney intestine Kidney- ↓Ca+. ↓Vit D Intestine- ↓Ca+, ↓Phos
What is the most common cause of hypercalcemia in hospitalized patients Malignancy is the most common cause
How does metastases cause hypercalcemia tumors metastasize to the bone and cause hyper calcemia
How do Solid Tumors such as lung-squamous cell, renal adenocarcinoma, breast cancer cause hypercalcemia These tumors secret PTH related protein (PTHrP) which acts like PTH and causes ↑Ca/↓phos by stimulating osteoclastic resorption of bone. This suppress native PTH by ↑serum calcium
HOw does multiple myeloma cause hypercalcemia abnormal plasma cells secrete osteoclastic activating factors leading to local bone destruction ↑Ca+
How do Granulomatous diseases such as sarcoidosis, TB, histoplasmosis, and Coccidiomycosis cause hypercalcemia Cuase ectopic secretion of 1,25-OH D3 leading to increase GI absorption of calcium and phosphorus
Why do thiazides sometimes cause hypercalcemia as a s/e Increaes reabsroption of Ca+ at the distal tubule
How does lithium cause hypercalcemia increases set point for PTH secretion you need higher levels of Ca+ to have negative feedback effects on PTH secretion
How does chronic Antacid use cause hypercalcemia the aluminumin the antacid binds phosphate and decreases phosphorus which stimulates osteoclast resorption of bone
How does Vit D intoxication lead to hypercalcemia increases GI absorption of Ca+
how does Vit A intoxication lead to hypercalcemia Increases osteoclastic activity
What is milk-alkali syndrome occurs after ingestion of large amounts of calcium and alkai where metabolic alkalosis results in decreased renal excretion of Ca+ and later leads to hypercalcemia
How does hyperthyroidism cause hypercalcemia Increased T4 stimulates osteoclastic activity and suppress Vit D
This is an autosomal dominant disease w/ Onset of Hypercalcemia in first two decades of life. Renal hypersensitivity to PTH renal absorp. of Ca+. PTH level normal Distinguish from Hyperparathyroidism by low 24-hour urinary Ca+ excretion. Familial Hypocalciuric Hypercalcemia: Patients are asymptomatic: No PUD or kidney stones
abnormality in parathyroid glands that causes inappropriate PTH secretion. Primary Hyperparathyroidism
What is the most common cause of hypercalcemia in outpatients primary hyperparathyroidism
What is the primary cause of primary hyperparathyroid 84% are due to a single parathyroid benign adenoma
Why do you still get PTH secretion from a parathyroid benign adenoma even when calcium levels are high Tumor functions autonomously free from negative feedback so you will have ↑Ca+, ↑PTH, and ↓Phos
What is the minor cause of primary parathyroid 15% are due to parathyroid gland hyperplasia Chief Cells enlarge and replace normal stromal fat. Usually hereditary and involve more than one gland
What does MEN stand for in regard to primary hyperparathyroid Multiple Endocrine Neoplasia
What are the s/sx of MEN type I (werner's syndrome) hyperparathyroidism (adenoma) peptic ulcer disease pancreatic islet tumors (insulinoma) pituitary adenomas
What are the s/sx of MEN type IIa (Sipple's syndrome) Hyperparathyroidism Medullary Thyroid Cancer Pheochromocytoma
What gene is messed up in MEN I menin Gene
What gene is messed up in MEN IIa Ret proto-oncogene
What percent of primary hyperparathyroid is actually caused by malignant parathyroid carcinomas 1%
what are really RARE causes of Primary Hyperparathyroid Palpable neck mass of metastatic carcinomas of the lung, breast or kidney
What are the causes of secondary hyperparathyroid Renal Failure Fanconi Syndrome Malabsorption
How does renal failure cause secondary Hyperparathyroid Damaged kidney can't make enough Vit D (1,25OH-D3) Won't absorb calcium from GI tract Calcium will decrease PTH will increase Kidney also can't excrete phosphorus so ↑Phos
What would you labs likely show in kidney failure when testing for secondary hyperparathyroid ↓1,25-OH D3, ↓Ca+, ↑Phos, ↑PTH
How does fanconi's syndrome cause secondary hyperparathyroid Damage to proximal renal tubule ↓ Ca+ absorption and phosphorus in renal glomeruli; Leading to increased PTH
How does malabsorption lead to hyperparathyroid causes severe Vit D deficiency, Reducing hepatic 25OH-D3, Impaired absorption of Ca+ and phosphorus in GI. Low Ca+ = High PTH
What would the labs look like in malabsorption when looking at hyperparathyroid ↓25-OH D3, ↓1,25-OH D3, ↓Ca+, ↓Phos, ↑PTH
What is tertiary hyperparathyroid autonomous parathyrod hyperfunction ↑PTH, This develops from long-term secondary hyperparathyroidism
When are you likely to see tertiary hyperparathyroid seen after renal transplant and creates hypercalcemia
What are the s/sx of hypercalcemia bones, stones, abdominal groans and psychic moans.
What musculoskeletal s/sx would you expect in hypercalcemia muscle weakness (general malaise fatigue) Diminished deep tendon relfexes (hypotonia Pseodogout(calcium pyrophospahte crystals) Bone Pain due to osteitis fibrosa cystica
What is the classical skeltal finding in hyperparathyroidism osteitis fibrosa cystica salt and peper looking loss of bone in distal phalanges and skull leads to bone cysts or brown tumors
What are brown tumors brown tumors are more severe form of osteitis fibrosa cystica. Habe brown fibrotic tissue collections in cystic spaces of bone due to ↑PTH excessive bone absorption and pathologic bone fractures
Why do you get pruritis in hypercalcemia calcification of skin
What is band keratopathy calcification of the limbus of the eye
What GI s/sx will you have in hypercalcemia Constipation Nausea and Vomiting Abdominal Pain (groans) -pancreatitis -peptic ulcer disease (PUD) anorexia
why do you get pancreatitis in hypercalcemia from calcification of the pancreas
Why od you see Peptic Ulcer Disease PUD in hypercalcemia high calcium stimulates gastrin release
What renal s/sx will you see in hypercalcemia volume depletion due to polyuria(kidney is trying to get rid of excess Ca+ nephrocalcinosis Kidney Stones- calcium oxalate
What is Nephrocalcinosis Calcification of renal tubules in hypercalcemia
What cardiovascular problems will you see with hypercalcemia hypotension cardiac arrythmias -bradycardia -short Q-T interval -Heart Block
What neurologic s/sx will you see in hypercalcemia psychosis personality changes confusion lethargy apathy obtundation coma
In hyperparathyroid what will you see in serum Ca+ Serum Phos PTH Other findings Serum Ca+- ↑ Serum Phos- ↓ PTH- ↑ Other findins- Bone loss
In Primary Carcinoma what will you see in serum Ca+ Serum Phos PTH Other findings Serum Ca+- ↑ Serum Phos- ↓ PTH- nl Other findins- PTHrp, lesion on C-xray bone lesions
In metastatic Carcinoma what will you see in serum Ca+ Serum Phos PTH Other findings Serum Ca+- ↑ Serum Phos- nl PTH- ↓ Other findins- PTHrp, lesion on C-xray bone lesions
In Multiple Myeloma what will you see in serum Ca+ Serum Phos PTH Other findings Serum Ca+- ↑ Serum Phos- nl PTH- ↓ Other findins- urine bence jones protein
In Sarcoidosis what will you see in serum Ca+ Serum Phos PTH Serum Ca+- ↑ Serum Phos- ↑ PTH- ↓ Other findins- ↑1,25-OH D3
In Vit D intoxication what will you see in serum Ca+ Serum Phos PTH Serum Ca+- ↑ Serum Phos- ↑ PTH- ↓ Other findins- ↑1,25-OH D3
In Milk Alakali Syndrome what will you see in serum Ca+ Serum Phos PTH Serum Ca+- ↑ Serum Phos- nl PTH- ↓ Other findins- Hx PUD
In thryotoxicosis what will you see in serum Ca+ Serum Phos PTH Serum Ca+- ↑ Serum Phos- nl PTH- ↓ Other findins- ↓TSH, ↑T4/T3
What would you be looking for in FX for hypercalcemic patient familial hypocalciuric hypercalcemia MEN syndromes
What would you be looking for in reviewing meds of hypercalcemic patient thiazide diuretics Vit A or D lithium
What would you be looking for as a red flag for hypercalcemic patient in their past medical history thryoid/adrenal disease history of kidney stones history or symptoms of cancer hypophophatemia in vegetarians and alcoholics
How do you calculate true calcium level .8 x (4-measured albumin) + serum calcium
What labs values do you want to work up in hypercalcemia Serum Ca+ Phosphorus level PTH TSH/free T4 Cortisol chest x-ray EKG 24 hour urine collection
What do you need to do if your patients calcium is 14mg/dl or greater the need to be hospitalized, if in hypercalcemia crisis- dehydrated, encephalopathy, cardiac arrhythmias give them FLUID FLUID FLUID FLUID FLUID
what is the first step in tx of hypercalcemia correct volume depletion FLUID FLUID FLUID normal saline 2-6 liters a day for 48 hours this volume expansion will enhance renal excretion of Ca+
If you took the fluid therapy too far in hypercalcemic patient what can you order Loop diuretics(furosemide;lasix) not thiazides to promote fluid excretion w/o calcium retention
What drugs would you probably stop in patient with hypercalcemia stop thiazides, lithium or other Ca+ concentrating drugs
What will you need to order for patients suffering from hypercalcemia and renal failure Dialysis will be required to remove calcium
If the cause of the hypercalcemia is hyperparathyroidism what will your patient need patient will need surgery to correct the problem
you are preping a patient for parathyroidectomy what will you order to find the abnormal parathyroid gland that needs to be removed you will order a sestamibi scan. it is absorbed by all thyroid and parathyroid tissue but gets stays in abnormal parathyroid tissue.
You have just finished a parathyroidectomy now what do you want to monitor your patient for monitor for hypocalcemia
what do you first have to do in your hypercalcemic patient with hyperparathyroid before you can cut out the offending abnormal parathyroid gland get patients calcium level decreased to a safe level as parathyroidectomy is not emergent (immediately needed)
If malignancy if found what should you do refer to oncologist
What should you use in hypercalcemia with granulomatous disease corticosteroids- hydrocrotisone which may increase digitalis toxicity, osteoporosis, elevated blood sugar
How does bisphosphonates aid in treating hypercalcemia it binds hydroxyapatite crystals in bone matrix and prevent osteoclasts attaching to the bone to cause resorptiong of calcium and phosphorus
what is pamidronate bisphophonate that prevents bone resorption least toxic s/e= transient increase in body temp mild GI distress mild hypophophatemia hypokalemia and hypomagnesemia
What hormone therapy may aid in tx hypercalcemia calcitonin- inhibits bone resorption and increases excretion of calcium. Can provide analgesia for bone pain
What is plicamycin osteoclast RNA synthesis inhibitor. Quick onset and lasts for several days but may cause thrombocytopenia, bleeding, is hepatotoxic and nephrotoxic
What are the s/e of using a bone resorption inhibitor like gallium nitrate is nephrotoxic so caution in renal failure
What may be causes of hypocalcemia hypoparathyroid-most common Extensive radiation- hungry bone syndrome after parathyroidectomy autoimmune hypoparathyroid Congenital Hypomagnesemia pseudohypoparathyroidism
What is the most common cause of hypoparathyroid leading to hypocalcemia post surgical excision of all parathyroid glands during surgery in neck for thyroid, laryngeal or neck malignancies
Why would extensive radiation in the neck or face lead to hypocalcemia it may cause destruction of all 4 parathyroid glands leading to hypoparathyroid and decreased PTH
What is hungry bone syndrome and why does it cause hypocalcemia after parathyroidectomy- removal of the overactive parathyroid gland drops PTH levels alot. bones have been starved for ca+ by high PTH now start to hold onto ca+ to remineralize free Ca++ drops and you get hypocalcemia until PTH secretion resumes
How does autoimmune hypoparathyroidism cause hypocalcemia polyglandular syndrome: HAM syndrome (hypoparathyroid-addison's-mucocutaneous candidiasis) is autoimmune destruction of parathyroid gland. Leads to hypocalcemia by age 7-10
Which congenital defects are also associated with hypocalcemia digeorge syndrome- congenital abscence of the glands Fetal alcohol syndrome teratogentic defects mutations of chromosome 3q
Why does hypomagnesemia cause hypocalcemia low levels (<1.2mg/dl) of mangesium interfer with PTH activity may be caused by alcoholism, diarrhea, pancreatitis
What is pseudohypoparathryoidism mutation in PTH receptor/resistance to PTH causes hypocalcemia
What are the clinical signs that a patient suffers from pseudohypoparathyroidism short stature round faces mild mental retardation knuckle, knuckle, dimple dimple when they make a fist (short 4th and 5th metacarpal bones) nodules, sub q tissue calcifications obesity
what will you lab results be in a pseudohypoparathyroid patient low Ca+, HIgh phos, High PTH
If patient is pseudohypoparathyroid what would you expect to see on a CT scan of the head and X-ray of the hand CT scan of head: shows basal ganglion calcification X-ray of hand: loss of bone in distal phalanges/short metacarpals
if you suspect your patient may suffer from pseudohypoparathyroid what test can you run to help confirm you dx have patient fast overnight measure labs at 8am then give the PTH at 9am 2 days in a row the see if there is a 10-20 fold increase in UcAMP if not they have pseudohypoparathyroid
What is the tx for pseudoparahypothryoid since PTH is ineffective you need to give Ca+ and Vit D to correct hypocalcemia.
What do all the following have in common in regards to Ca+ Sepsis or Toxic shock syndrome Infiltrative disease: Hemochromatosis or Wilson’s disease Fat emboli Pancreatitis they can all cause hypocalcemia
what effect can hypoalbuminemia have on Ca+ levels it is a low protein state that can effect free levels of Ca+ don't forget you have to account for albumin levels when getting corrected Ca+ levels (measured Ca+) + ( 4.0-albumin) x 0.8 = corrected Ca+
Why do loop diuretics (lasix) cause hypocalcemia they increase renal excretion of calcium
HOw does alcohol cause hypocalcemia suppresses PTH
HOw do aminoglycosides, cisplatin, and amphotericin B cuase hypocalcemia cause low Mg+ decreases PTH efficacy
How do phenytoin and phenobarbital cause hypocalcemia both break down Vit D which results in decreased Ca+ absorption in the gut
how does cimetidine cause hypocalcemia lowers gastric PH as an H2 blockers this slows fat breakdown, fat is necessary to complex Ca+ for gut absorption
What do the following have in common in regards to Ca+ Fluoride High phosphate states high citrate states high bicarb states high lactate states all cause chelation of Ca+ lowering free Ca+ levels causing HYPOCALCEMIA
What Malignancies are possible causes of hypocalcemia: Osteoblastic Metastasis: Breast and Prostate cancers. Excess Calcitonin: Medullary Thyroid cancer
If you have a Vit D deficiency what will happen to Ca+ you will have hypocalcemia
What are causes of Vit D deficiency limited sun exposure rickets- can't convert 25OHD3 to 1,25OHD3 Osteomalacia
What is rickets failure of normal bone mineralization at growth plate in children due to a lack of Vit D response
what are the s/sx of rickets Infants are restless, sitting/crawling delayed, delayed fontanels closer Older infants: delayed walking due to pain, Bowed legs, knock-knees
What are the two types of rickets and their causes rickets type I: defect in 1,25OHD3 hydroxylase in the kidney (can't change 25OHD3 to 1,25OHD3) Rickets type II: receptor deficiency to 1,25OHD3
What will your labs look like in rickets Low Ca+ Low Phos High PTH Low 25OHD3
What is tx for Rickets type I and what is the tx for rickets type II type I: calcitriol Type II: ergocalciferol
What is osteomalacia failure of bone matrix to mineralize normally
What are the s/sx of osteomalacia waddling gait- due to proximal muscle weakness and pain Deformities caused by fractures in ribs, vertebrae, and long bones Brisk deep tendon reflexes (from hypocalcemia) Muscle hypotonia (hypocalcemia) rarely tetany (hypocalcemia)
What are possible causes of osteomalacia Malabsorption Impaired renal synthesis of 1,25 OH-D3 Phosphate Deficiency Drug induced Toxin induced
What will you find on labs in ostemalacia decreased urinary calcium lose serum calcium low 25OHD3 incrased alkaline phophatase(from osteoblast) low phosphorous elevated PTH (response to low Ca+)
What will you find on x-ray in patient with osteomalacia decreased bone density pseudofractures
What is the most common cause of ostemalacia malabsorption
what is malabsorption reduced absorption of Ca+ and Vit D results in fecal loss of Vit D and Ca+
What are some common causes of Malabsorption Crohn's disease Celiac's disease Chronich Steatorrhea Surgical Resection Biliary fistula
How do Crohn's and Celiac disease cause malabsorption cause a reduced surface area to absorb calcium and phosphorus in GI
What may cause chronic steatorrhea causing malabsorption pancreatitis
Why would surgical resection cause malabsrotption if you cut out small intestine you are cutting out the area where absorption of vit D and calcium occurs so you get malabsorption
What is the tx for malabsorption give large dose of ergocalciferol but you may still need to give an IM or IV dose because absorption is so reduced
What may lead to impaired renal synthesis of 1,25OHD3 chronic renal disease-impairs production hypoparathyroidism-no stimuli to hydroxylate congenital absence of hydroxylating enzymes- Rickets type 1 malignant tumors secreting substances that suppress synthesis of 1,25OHD3
what are some causes of phosphate deficiency low dietary intake of phosphate excessive ingestion of aluminum hydroxide heritable x-linked hypophosphatemia Fanconi's syndrome Tumors
What drugs induce osteomalacia excessibe bisphophonate use fluoride anticonvulsive meds
What toxins cause osteomalacia aluminum lead cadmium
What do you see in the following lab results with hypoparathyroidism Ca+ PO4 PTH 25OHD3 Ca+-↓ PO4-↑ PTH-↓ 25OHD3-nl
What do you see in the following lab results with hypoposphatemia Ca+ PO4 PTH 25OHD3 Ca+-nl PO4-↓ PTH-nl 25OHD3-nl
What do you see in the following lab results with Vit D deficiency Ca+ PO4 PTH 25OHD3 Ca+-↓ PO4-↓ PTH-↑ 25OHD3-↓
What do you see in the following lab results with Malabsorption Ca+ PO4 PTH 25OHD3 Ca+-↓ PO4-↓ PTH-↑ 25OHD3-↓
What do you see in the following lab results with chronic renal failure Ca+ PO4 PTH 25OHD3 Ca+-↓ PO4-↑ PTH-↑ 25OHD3-↓1,25OH-D3
what is trousseau's sign s/sx of hypocalcemia- infalte a b/p cuff above systolic pressure for a few minutes and then you get flexion of the writs and metacarpophalangeal joints; hyperextension of the fingers, flexed thumb on palm.
What is chvostek's I sign tapping facial nerve causes twitching of the ipsilateral facial muscles
What is chvostek's II sign tapping at zygomtaic prominence causes twitching in facial muscles circumoral muscles and orbicularis oculi on ipsilateral side
what are the Cardio Vascular s/sx of hypocalcemia hypotension congestive heart failure
What changes will you see on an EKG with hypocalcemia prolonged Q-T interval Prolonged S-T interval normal T waves
would the following indicate hyper or hypo calcemia Hyperirritability Anxiety Mood Swings Hoarseness (due to laryngospasm) Seizures Muscle cramps: involving lower back, legs and feet Parethesias: involving fingertips, toes, perioral) hypocalcemia
What is the tx for hypocalcemia IV infusion of Ca+ to restore normal levels chronic management w/ calcium carbonate Vit D supplement
If you have a symptomatic patient with clinical signs of hypocalcemia what do you need to do immediate resuscitation check vitals for signs of sepsis/trousseau's Check surgical history for parathyroidectomy, pancreatectomy
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Created by: smaxsmith