Endocrinology
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| Calcium and Phosphorus provide a major role in | metabolic control of mineral homeostasis
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| What makes up 85% of the body's skeletal mass? | Appendicular skeleton
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| Total body calcium content | 1000 gram
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| What regulates Calcium? | Mainly PTH; Calcium is tightly regulated
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| What compound is necessary to absorb calcium and phosphate from the gut? | 1,25 OH D (produced by the kidney)
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| What is the importance of calcium with phosphorus? | Necessary to mineralize bone
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| What is an AE of HCTZ | High blood calcium
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| 1/2 of the calcium in the blood is bound to? | albumin
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| Unbound calacium is called | Free/Ionized Calcium
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| Hypercalcium serum calcium level | >10.5mg/dl
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| Signs and sx of hypercalcemia | altered mentation, nausea, vomiting, polyuria, polydipsia, stones
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| Pathogenesis of Hypercalcemia | Accelerated bone resorption by osteoclasts, enhanced GI absorption of calcium may contribute, eclipsed renal capacity to excrete calcium load
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| Most common cause of outpatient hypercalcemia | Primary Hyperparathyroidism; inpatient-malignancy (these two account for 95% of all cases of hypercalcemia)
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| Over use of antacids can cause | milk-alkali syndrome; too much calcium. Rare.
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| Hypocalcemia | low calcium, low PTH
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| Hypercalcemia | high calcium, high PTH
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| Malignancy | high Calcium, low PTH b/c PTH independent
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| Younger people <45 with hypercalcemia should be treated with | surgery.
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| Nonpharmacologic treatment of hypercalcemia | Fluids b/c they are dehydrated. Can give them loop diuretics after they are hydrated to get calcium out.
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| 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)
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| AE of bisphonates | may drop calcium too low
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| Low calcium can produce what sign? | Positive Chvostek's sign, positive trousseau's sign (which will produce carpal pedal spasm)
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| Gastric Bypass can cause | low vit D and thus hypocalcemia
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| Clinical manifestations of hypocalcemia | tetany, spasms, prolonged QT interval, hypotension, calcification of organs, paresthesias and muscle cramping.
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| Common causes of hypocalcemia | Post-surgical (vascular supply to parathyroids is very delicate), Hypoparathyroidism, Vitamin D deficiency, Magnesium deficiency
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| Treatment of Hypocalcemia | Calcium (2-4 mg/day), ergocalciferol if 25 OH D deficient, Calcitriol if 25 OH D sufficient
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| What is the potential risk of Calcitrol? | Hypercalciuria and hypercalcemia
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| Secondary hypocalcemia | low calcium and vit. D, High PTH
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| Bowing of femoral heads is a sign of | osteomalacia
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| Osteomalacia in childhood | rickets
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| Sx of Osteomalacia | Diffuse bone pain, waddling gait, muscular weakness, Pseudofractures "loozer's zones"
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| Causes of Osteomalacia | low calcium, low phosphorus or deficient mineralization of bone in the presence of nl levels of calcium and phosphorus
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| Fanconi syndrome is what type of Osteomalacia | Phosphopenic Osteomalacia
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| Too much phosphate can cause | decrease in Calcium, increase in PTH
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| Treatment of Osteomalacia | Vit D replacement. Calcium, Ergocalciferol, Calcitrol
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| Paget's Disease | localized disorder of bone remodeling, initiating lesion is increased bone resorption
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| What is the hallmark of Paget's dz? | Elevated Akaline phosphatase; bone turnover markers are often elevated
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| Treatment of Paget's | Inhibit osteoclast resorption/bone formation. Higher doses of bisphosphonates, calcitonin
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