Wannamaker 10-23-07 Calcium And Phosphorus Abn

Front 1

Potassium or Calcium?

Neuromuscular signaling
Cardiac contractility
Hormone secretion
Blood coagulation

Back 1

Calcium

Front 2

At what level of hypercalcemia does a pt get symptomatic?

Back 2

12


9 – 10.5 mg/dl: Normal
11 – 11.5 mg/dl: Asymptomatic, lab abnormality only

Front 3

What are symptoms of hypercalcemia

Back 3

Neuropsychiatric symptoms, polyuria, polydipsia

Front 4

The primary manifestation of hypercalcemia on EKG

Back 4

marked decrease in the duration of the ST segment


First degree AV block may be seen

Front 5

TEST QUESTION

2 big Causes of Hypercalcemia

Back 5

Primary hyperparathyroidism

Hypercalcemia of malignancy

Front 6

TEST QUESTION

Most common cause of hypercalcemia (90%)

Back 6

Primary Hyperparathyroidism

Front 7

TEST QUESTION

Describe weight loss and phosphorus in Primary hyperparathyroidism

Back 7

No associated weight loss

Decreased phosphorus

Front 8

TEST QUESTION

Second most common cause of hypercalcemia, but diagnosis you do not want to miss.

Back 8

Hypercalcemia of Malignancy

Front 9

TEST QUESTION

Describe weight loss and phosphorus in Hypercalcemia of Malignancy

Back 9

10% of body weight loss

normal phosphorus

Front 10

TEST QUESTION

Describe PTH in Hypercalcemia of Malignancy

Back 10

low PTH (normal feedback response)

Front 11

TEST QUESTION

If not PTH, what is causing the hypercalcemia in "Hypercalcemia of Malignancy"

Back 11

PTH-related peptide (PTHrP)

Front 12

Hypercalcemia work-up

Back 12

Repeat calcium, and obtain ionized calcium
Intact Parathyroid Hormone (PTH) level
Thyroid Stimulating Hormone (TSH), +/- FT4

Malignancy suspected: Parathyroid Hormone related Peptide (PTHrP)

Multiple myeloma suspected: Protein electrophoresis

Front 13

Treatment of Hypercalcemia

Back 13

Asymptomatic: treat underlying cause

Symptomatic:
I.V. Hydration: 4-6 liters over 24 hours
After volume replacement, or if concern for fluid overload, loop diuretics
Furosemide (Lasix) 20mg I.V. every 6 hours
Lasix Increases Sodium and Calcium excretion
Treat underlying homeostasis problem

Front 14

What do Bisphosphonates do to hypercalcemia pt?

Back 14

Increase calcium resorbtion into bone

Front 15

What do Glucocorticoid steroids do to hypercalcemia pt?

Back 15

Reduce 1,25 (OH)2 D mediated effects

Hydrocortisone (Cortef, Solu-Cortef) 300mg daily for 3 – 7 days

Front 16

TEST QUESTION

What causes factitious hypocalcemia?

Back 16

Low albumin

Front 17

TEST QUESTION

Correction factor, for every drop of albumin by 1mg/dl < 4g/dl, need to increase calcium by _______

Back 17

0.8mg/dl

Front 18

TEST QUESTION:

Most important cause of Hypocalcemia

Back 18

Parathyroid destruction: Surgical

Front 19

TEST QUESTION

Most important cause of High Parathyroid Hormone Levels (Secondary Hyperparathyroidism)

Back 19

Renal insufficiency with impaired 1,25(OH)2D production

Front 20

Presentation of Hypocalcemia:

"signs and symptoms, etc"

Back 20

Asymptomatic
Parasthesias of fingers/toes
Chvostek’s sign
10% of normal individuals
Trousseau’s sign

Front 21

twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear

Back 21

Chvostek’s sign

Front 22

Carpal spasm may be induced by inflation of a blood pressure cuff to 20 mmHg above the patient's systolic blood pressure for 3 min

Back 22

Trousseau’s sign

Front 23

Treatment of Mild Hypocalcemia

Back 23

Oral calcium supplement (i.e. calcium carbonate/Tums 500mg TID on empty stomach)
and Vitamin D2 or D3 (i.e. Citracal + D: 2 tabs BID, 315mg calcium citrate and 200 units vitamin D3)
or Calcitrol (Rocaltrol) [1,25 (OH)2 D] 0.25 – 2 microgram daily

Front 24

Treatment of Severe Hypocalcemia

Back 24

Calcium Gluconate I.V. over 5 minutes

Front 25

The electrolyte that needs to be ordered specifically, b/c it is not included in most electrolyte panels.

Back 25

Phosphorus

Front 26

Why is it hard to know what level of Phosphorus you have?

Back 26

it is an intracellular ion

Front 27

TEST QUESTION

Important Causes of Hypophosphatemia

Back 27

Alcoholism

Ethanol

Front 28

TEST QUESTION

important causes of
Shifts of extracellular phosphate into cells

Back 28

A. Intravenous glucose
B. Insulin therapy of prolonged hyperglycemia or diabetic ketoacidosis

Front 29

TEST QUESTION

Important cause of Inadequate intestinal absorption of phosphorus

Back 29

Malnutrition, especially ***alcoholics***
Calcium supplements
Phosphate binders (i.e. Sevelamer/Renagel)

Front 30

TEST QUESTION

Important cause of Rapid redistribution of phosphorus

Back 30

Insulin treatment of Diabetic Ketoacidosis

Front 31

TEST QUESTION

Treatment of Hypophosphatemia

Back 31

Correct hypocalcemia (and hypomagnesemia) first
Oral therapy: 750 – 2,000 mg daily
Intravenous therapy (NaPO4 or KPO4)
****0.8 mmol of phosphorus component per kg IVPB over 6 hours*****


IVPB = IV piggyback

Front 32

For diabetetic pt in ketoacidosis, give NaPO4 or KPO4?

Back 32

KPO4

Front 33

Causes of Hyperphosphatemia

Back 33

Impaired glomerular filtration rate
Hypoparathryoidism
Excessive phosphate
From gut
From bone
From parenteral nutrition therapy

Front 34

Most important disease with which you see hyperphosphatemia

Back 34

CKD

Front 35

Fancy word for calcium phosphate precipitates

Back 35

calciphylaxis

Front 36

Treatment for Hyperphosphatemia

Back 36

Volume expansion
Limit absorption

Front 37

Drugs that limit phosphorus absorption

Back 37

Aluminum hydroxide antacids (i.e. Maalox)
Sevalamar (Renagel)