Uploaded byDr Muhammad Mustansar
Calcium Metabolism
This document summarizes disorders of calcium metabolism, including hypercalcemia and hypocalcemia. It discusses etiologies such as increased GI absorption, decreased bone mineralization, and decreased urinary excretion that can cause hypercalcemia. Signs and symptoms of hypercalcemia include malaise, constipation, and psychosis. Treatment involves hydration, loop diuretics, calcitonin, and bisphosphonates. Etiologies of hypocalcemia include decreased GI absorption and vitamin D deficiency, increased urinary excretion, and decreased bone resorption. Symptoms include neuromuscular irritability and tetany. Treatment involves IV calcium initially and later oral calcium and vitamin D supplementation.
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Calcium Metabolism
- 2. DISORDERS OF CALCIUM METABOLISM Dr Shamim Akram
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- 14. ETIOLOGIES OF HYPERCALCEMIA IncreasedGI Absorption Decreased Bone Milk-alkali syndrome Mineralization Elevated calcitriol Vitamin D excess Elevated PTH Excessive dietary intake Aluminum toxicity Granuomatous diseases Elevated PTH Hypophosphatemia Decreased Urinary Excretion Increased Loss From Bone Thiazide diuretics Increased net bone resorption Elevated calcitriol Elevated PTH Hyperparathyroidism Elevated PTH Malignancy Osteolytic metastases Increased bone turnover Paget’s disease of bone Hyperthyroidism
- 15. 15 CAUSES Approx. 80% of all cases are caused by Malignancy or Primary Hyperpathyroidism • V Vitamins T Thiazide, • I Immobilization other drugs - Lithium • T Thyrotoxicosis R Rabdomyolysis • A Addison’s disease A AIDS • M Milk-alkali syndrome P Paget’s disease, • I Inflammatory disorders Parental nutrition, Pheochromocytoma, • N Neoplastic related Parathyroid disease disease • S Sarcoidosis
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- 18. SIGNS AND SYMPTOMS Bones, stones, abdominal groans, and psychic moans. • Malaise, fatigue, headaches, diffuse aches and pains, constipation. • Patients are often dehydrated • Lethargy and psychosis when hypercalcemia is severe. • Calcifications in skin, cornea, conjunctiva, and kidneys. 18
- 19. CLINICAL 1. Renal ; , stone, nephrocalcinosis 2. GI ;, Constipation, PU, Pancratitis 3. Neuro ; Weakness, Drowsiness, Apnea 4. Cardio ; Short QT <0.3 ,Broad T, Heart Block, Vent arrhythmia,Asystole, Sense to digoxin 5. Musculo ; Cramp, Bone pain, Pathologic Fx 6. Others ; Band Keratopathy 19
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- 21. DIAGNOSIS Detailed historyand physical examination… PTH level Vitamin D level Serum calcium levels Urine evaluation Ultrasound X-RAYS,MRI,CT scan PET(Positron Emission Tomography
- 22. MANAGEMENT HYPERCALCEMIA General Hydration 2-4L/day Keep urine output > 1-2 ml/kg/hr onset 12-24 hr Lasix 10-20 mg iv. q 6-12 hr * only after adequate hydration * Mobilization Dialysis 22
- 23. MANAGEMENT HYPERCALCEMIA Specific Calcitonin Bishosphonates Galliumnitrite Plicamycin, Mithramycin Hydrocortisone 23
- 24. ETIOLOGIES OF HYPOCALCEMIA DecreasedGI Absorption Poor dietary intake of calcium Impaired absorption of calcium Vitamin D deficiency Increased Urinary Excretion Poor dietary intake of vitamin D Malabsorption syndromes Low PTH Decreased conversion of vit. D to thyroidectomy calcitriol Liver failure I131 treatment Renal failure Autoimmune hypoparathyroidism Low PTH PTH resistance Hyperphosphatemia Vitamin D deficiency / low calcitriol Decreased Bone Resorption/Increased Mineralization Low PTH PTH resistance pseudohypoparathyroidism) Vitamin D deficiency / low calcitriol Hungry bones syndrome Osteoblastic metastases
- 25. SYMPTOMS AND SIGNSOF HYPOCALCEMIA Neuromuscular irritability Paresthesias Laryngospasm / Bronchospasm Tetany Seizures Chvostek sign Trousseau sign Prolonged QTc time on ECG
- 28. Trousseau sign: (very uncomfortable and painful) A blood pressure cuff is inflated to a pressure above the patients systolic level. Pressure is continued for several minutes. Carpopedal spasm: * flexion at the wrist * flexion at the MP joints * extension of the IP joints * adduction thumbs/fingers
- 29. Long QT interval with normal T waves Prolongation of the ST segment with little shift from the baseline
- 30. TREATMENT HYPOCALCEMIA Symptomatic hypocalcemia needs IV calcium and continuous monitoring for arrhythmias. Once serum Ca is in safe range ( >7 mg/dl) IV Ca can be stopped, and oral Ca started. Oral Ca and vit D are initiated as soon as possible when patient is tolerating oral feed. Active form of vit D is preferred in treatment of HPH and hyperphosphatemia because both impair activation of 25 OH vit D by one alpha hydroxylase. Diet, no specific diet is required but adequate Ca and vit D intake is recommended.
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