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Calcium Abnormalities (Hypocalcaemia (Clinical Features: (Mental state…
Calcium Abnormalities
Hypocalcaemia
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Investigations:
Bloods: CMP, PTH, Vit D, UEC's, albumin, lipase
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Clinical Features:
Mental state changes: irritability, confusion, hallucinations, anxiety
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Brittle hair, patchy alopecia, brittle nails
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Dermatitis, eczema, hyperpigmentation
Management:
- Correct any hypomagnesaemia (must be corrected 1st)
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Causes:
Low PTH:
Parathyroid destruction: surgery (largest cause), radiation injury, autoimmune, tumour
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Hypomagnesaemia (causes include malabsorption, PPI's, and chronic ETOH) leads to PTH resistance
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Other: acute severe illness: pancreatitis, rhabdo, tumour lysys syndrome; IV bisphosphonates in patients with untreated vit D deficiency
Hypercalcaemia
Management:
- Increase GIT excretion: via glucocorticoids as they decrease calcium absorption
- Prevent bone resorption: via IV bisphosphonates (inhibit osteoclasts) OR calcitonin (opposite in action to PTH)
- Increase urinary excretion: loop diuretics and rehydration
- Avoid aggravating factors e.g. thiazide diuretics, dehydration, prolonged bed rest and high calcium diet
- Treat the underlying cause
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Clinical Features:
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Other: 50% asymptomatic, N&V, lethargy, anorexia, constipation, muscle weakness, decreased reflexes, HTN
Causes:
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Low PTH:
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Thiazide diruretics: Cl/Na pump at tubular side of DCT cells is blocked --> lower intracellular Na --> increased activity of Na/Ca exchanger at luminal end which iincreases intracellular Na and Ca in the blood
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Investigations:
Bloods: CMP, PTH, Vit D, UEC's, albumin
Tests to consider: bone scan, 24hr urine calcium (high in primary hyperparathyroidism), CXR (sarcoidosis)
- 40% of circulating Ca is bound to Albumin