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Calcium Disorders
Endocrinology
| Question | Answer |
|---|---|
| Calcium and Phosphorus provide a major role in | metabolic control of mineral homeostasis |
| What makes up 85% of the body's skeletal mass? | Appendicular skeleton |
| Total body calcium content | 1000 gram |
| What regulates Calcium? | Mainly PTH; Calcium is tightly regulated |
| What compound is necessary to absorb calcium and phosphate from the gut? | 1,25 OH D (produced by the kidney) |
| What is the importance of calcium with phosphorus? | Necessary to mineralize bone |
| What is an AE of HCTZ | High blood calcium |
| 1/2 of the calcium in the blood is bound to? | albumin |
| Unbound calacium is called | Free/Ionized Calcium |
| Hypercalcium serum calcium level | >10.5mg/dl |
| Signs and sx of hypercalcemia | altered mentation, nausea, vomiting, polyuria, polydipsia, stones |
| Pathogenesis of Hypercalcemia | Accelerated bone resorption by osteoclasts, enhanced GI absorption of calcium may contribute, eclipsed renal capacity to excrete calcium load |
| Most common cause of outpatient hypercalcemia | Primary Hyperparathyroidism; inpatient-malignancy (these two account for 95% of all cases of hypercalcemia) |
| Over use of antacids can cause | milk-alkali syndrome; too much calcium. Rare. |
| Hypocalcemia | low calcium, low PTH |
| Hypercalcemia | high calcium, high PTH |
| Malignancy | high Calcium, low PTH b/c PTH independent |
| Younger people <45 with hypercalcemia should be treated with | surgery. |
| Nonpharmacologic treatment of hypercalcemia | Fluids b/c they are dehydrated. Can give them loop diuretics after they are hydrated to get calcium out. |
| Pharmacologic treatment of hypercalcemia | Inhibit osteoclastic resorption: bisphosphonates, calcitonin, cinacalcet. Glucocorticoids(if person is going to surgery or vit. D deficient, they could become hypocalcemic, so drugs are not as necessary) |
| AE of bisphonates | may drop calcium too low |
| Low calcium can produce what sign? | Positive Chvostek's sign, positive trousseau's sign (which will produce carpal pedal spasm) |
| Gastric Bypass can cause | low vit D and thus hypocalcemia |
| Clinical manifestations of hypocalcemia | tetany, spasms, prolonged QT interval, hypotension, calcification of organs, paresthesias and muscle cramping. |
| Common causes of hypocalcemia | Post-surgical (vascular supply to parathyroids is very delicate), Hypoparathyroidism, Vitamin D deficiency, Magnesium deficiency |
| Treatment of Hypocalcemia | Calcium (2-4 mg/day), ergocalciferol if 25 OH D deficient, Calcitriol if 25 OH D sufficient |
| What is the potential risk of Calcitrol? | Hypercalciuria and hypercalcemia |
| Secondary hypocalcemia | low calcium and vit. D, High PTH |
| Bowing of femoral heads is a sign of | osteomalacia |
| Osteomalacia in childhood | rickets |
| Sx of Osteomalacia | Diffuse bone pain, waddling gait, muscular weakness, Pseudofractures "loozer's zones" |
| Causes of Osteomalacia | low calcium, low phosphorus or deficient mineralization of bone in the presence of nl levels of calcium and phosphorus |
| Fanconi syndrome is what type of Osteomalacia | Phosphopenic Osteomalacia |
| Too much phosphate can cause | decrease in Calcium, increase in PTH |
| Treatment of Osteomalacia | Vit D replacement. Calcium, Ergocalciferol, Calcitrol |
| Paget's Disease | localized disorder of bone remodeling, initiating lesion is increased bone resorption |
| What is the hallmark of Paget's dz? | Elevated Akaline phosphatase; bone turnover markers are often elevated |
| Treatment of Paget's | Inhibit osteoclast resorption/bone formation. Higher doses of bisphosphonates, calcitonin |
Created by:
ltm12