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Calcium :glass_of_milk: (Path: (Parathyroid glands: PTH in vesicles (PTH…

- - - - Bone
        
        elevation in Ca, PO4
      - Kidney: turns on 1,25 Vit D #
        
        reabsorption of Ca, excretion of PO4
        
        Kidney PO4 exceeds PO4 resorption from bone and GI
      - indirectly: GI #
        
        PTH: absorption of Ca and PO4
    - - every once in a while need to check VitD
  - - - normal albumin: 4
      - normal Ca: 10
      - for every 1 change in Albumin, Ca changes in opp direction by 0.8.
        
        eg. Alb 4/ Ca10 vs Alb 3/ Ca9.2
        
        Ca level is the exact same, because most of the calcium is ALBUMIN bound
        
        albumin is usually low, not high. If low Albumin and low Ca, ca might correct to normal ranges.
- - - - Corrects Ca?
        
        :check:(+) stop :no_entry:
        
        :green_cross:(-)
        
        Ionized Ca normal?
        
        :green_cross:(-) low
        
        Hypocalcemia :checkered_flag:
        
        tx: IV Ca :glass_of_milk:, (see other diseases for more specific tx)
        
        :check:(+) normal, bogus lab
        
        :no_entry:stop
  - - - Commonly Iatrogenic: history alone
        
        Thyroidectomy
        
        Parathyroidectomy
        
        Pt: s/s tetany and perioral tingling (postop 1d)
        
        Dx: low PTH, driving low Ca, PO4 irrelevant
        
        nothing to reabsorb or excrete phosphorus
        
        suppressed parathyroids atrophied
        
        May be autoimmune
    - - PTH insensitivity
      - Hi PTH, Low Ca, low PO4
        
        low PO4 bc low PTH
    - - :pencil2:VitD comes from dairy and sunshine
      - Pt: MILD not deranged, but w/ osteopenia
        
        risk: person who stays inside
    - - labs show : Hi PTH (Uworld)
        
        Dx: Labs Creatinine vs. Vit D
        
        :check:Low Vit D w/ normal Cr : Vit D Def :checkered_flag:
        
        Tx: Ca and VitD
        
        significant osteopenia
        
        bisphosphonates #
        
        hi dose PO VitD
        
        DEXA scan ≤2.0
        
        :warning: 25 VitD level, not 1,25
        
        :check:Hi Cr
      - early CKD, impairment of VitD formation
        
        2º hyperparathyroidism
        
        Tx: Ca and VitD
        
        also Cinacalcet to decrease PTH at the same time
      - Late stage CKD
        
        hi PO4, not low Ca probs
    - - drop in Ca is part of Ransom criteria, Disorder of inflammation, not Ca
- - - - 1º Autonomous secretion from single gland (Adenoma)
      - 2º Early renal failure: appropriate response to relative hypocalcemia
      - 3º- Autonomous secretion due to stimulation- Multiple adenomas
    - - pathologic fractures( low bone density)
      - brown tumors
        
        :pencil2:not malignancies, but destruction of bone
    - - if inappropriate rise in PTH, Kidney wins and PO4 falls
        
        CaSR should turn off, but Parathyroid continues to release independent of Ca blood
      - VitD not required
        
        autonomous production of PTH
        
        high PTH, low PO4, hi Ca
      - Determining which type
        
        Sestamibi scan
        
        1º: one gland lights up, other glands atrophied
        
        3º: chronically low Ca (inability to make VitD) leads to upreg of PTH, Constant stimulation of PTH causes multiple secreting adenomas
        
        Tx: same for both, Resection
        
        watch for hypocalcemia, atrophied glands may not come back fast enough
        
        Cinacalcet: for prevention of 3º hyperparathyroidism
  - - - Mets
        
        invades bone
        
        releases Ca and PO4
        
        normal inhibition of CaSR and low PTH
        
        Kidney can't win: PO4 rises
        
        Hi Ca, PO4, low PTH
      - Paraneoplastic syndrome
        
        SCC of the lung ("chest mass")
        
        PTHrp
        
        Kidney wins
        
        Dx: get PTHrp, elevated in paraneoplastic
        
        Hi Ca, low PO4, low (real) PTH
  - - - excess "artificial" VitD
        
        lots of Ca and PO4 absorption
        
        Hi Ca turns off PTH from parathyroid hormones
      - Looks like cancer
        
        Hi Ca, PO4, low PTH
        
        Dx: check 1,25 VitD
        
        Tx: Glucocorticoids (Uworld)
  - - - Dx: low Urine Ca
- - - - :pencil2:used to be furosemide and fluids
        
        loops block Ca reabsorption: calciuria
        
        but this is bad because drying patient out concentrates Ca
      - Volume, Volume,Volume,Volume,Volume,Volume and some Rx
        
        dilution is the solution (IV solution)
        
        need other meds:
        
        Phase: immediate
        
        Calcitonin IV, rapid on/rapid off (Ca at 18)
        
        probably not useful unless severe and symtomatic
        
        Phase: long term (standard)
        
        Bisphosphonates
        
        Mainstay: early bisphosphonates w/ early IV fluids
        
        Phase: intermediate
        
        Loop diuretics(not emphasized.)
        
        they got to be volume up
  - - - :check:(+) elevated Ca #
      - :green_cross:(-) elevated Ca
        
        stop :no_entry: