Hyper/hypocalcemia

Question 1

Importance of calcium?

Answer 1

1. Heart and skeletal muscle contractility are affected by calcium ions
2. Vital to nervous system function and are associated with blood clotting and bone mineralization.

Question 2

Normal calcium range?

Answer 2

The concentration of serum calcium is tightly regulated by parathyroid hormone (PTH) and 1,25-hydroxy vitamin D.
Reference ranges: 2.0 - 2.5 mmol/L

Question 3

Causes of hypercalcaemia?

Answer 3

1. increased bone resorption
2. increased calscium absorption

Question 4

Increased bone resorption causes of hypercalcaemia?

Answer 4

1. hyper parathyroidism
2. malignancy
3. myeloma
4. PTH-rp with malignancies
5. Thyrotoxicosis

Question 5

Increased calcium absorption causes of hypercalcemia?

Answer 5

1. Increase intake of ca
2. Increased Vitamin D

Question 6

Presentation of hypercalcaemia?

Answer 6

Malaise
Muscle weakness
Confusion
Nephrolithiasis
Distal RTA

Question 7

Causes of hypocalcemia?

Answer 7

1. decreased calcium absorption
2. deposition of calcium/loss
3. increased renal excretion
4. others

Question 8

Decreased calcium absorption causes in hypocalcaemia?

Answer 8

1. Hypoparthyroidisim
2. Low vitamin d
3. Hypomagnesemia
4. malabsorption

Question 9

Deposition of calcium/loss causes in hypocalcemia?

Answer 9

pancreatitis

Question 10

Increased renal excretion causes in hypocalcemia?

Answer 10

diuretics

Question 11

Other causes of hypocalcaemia?

Answer 11

1. low albumin
2. alkalosis
3. hyperphosphatemia

Question 12

Presentation of hypocalcemia - due to decreased calcium absorption?

Answer 12

1. Neuromuscular excitability
2. Tetany
3. seizures
4. confusion
5. Hyperreflexia
6. abnormal eye movements
7. circumoral tingling
8. Chvostek’s and Trousseaus’s sign

Question 13

Bones, Stones, Groans and Moans

Answer 13

1. bones - abnormal bone remodeling and fracture risk
2. stones - increased risk for kidney stones
3. groans - abdominal cramping, nausea, ileus, constipation
4. psychiatric overtones - lethargy, depressed mood, psychosis, cognitive dysfunction

Question 14

Hypocalcemia signs and symptoms?

Answer 14

1. easy fatigability
2. depression, anxiety, confusion
3. numbness and tingling in extremities and region around mouth
4. hyperreflexia, muscle cramps
5. Chvosteks sign and Trousseaus sign
6. laryngeal spasm
7. tetany, seizures
8. ventricular tachycardia

Question 15

Treatment of hypercalcemia?

Answer 15

1. Treat cause
2. Adequate rehydration 3-4 l/day
3. Intravenous bisphosphonates
4. Loop diuretics
5. Dialysis in extreme cases

Question 16

Treatment hypocalcemia?

Answer 16

1. Treat Cause
2. Oral Calcium supplements
3. Intravenous calcium gluconate
4. Vitamin D3