Hypercalcemia Nv s Cast 8.

5 10 5

my Idl

one oaiosiasis

osu
oaastoa.ru
amazing osmani

mostlyasymptomatic
887

cnn.e.c.of.owfpmiiii.ie

theadenoma

byinducingCaen

2nd m.cc symptomatic

I
Eeion bonecartreleased

trombones PTHspreeeased m c c squamouscell

I carrycot
cart

I 0

pre
may o
exogenous

inlaorteaseingranuloma

bone reaers 9
I

releasebonecart

I
s c.amT

Ptula

Gmc paraneoplastic Ayndrome Hypercalcemia

Eastsensor receptor Ca SR

Nr
fine to maintain 1W serum cast

Mech site PTA gland 0

Renal tubules 9 cast excretion C1OH thick limb

If CaSR 0 mutation occurs PTH 9 from

I castexcretion
mm kidney

Ha

s cart T HYPOCALCIURIA
FAMILIAL Hypocalciuric

Hypercalcemia

Unique genetic syndromes of Hypercalcemia

mutationof mutationof WILLIAM's

PTAreceptors nitD receptors syndrome

PTH xp n

JANSEN'S INSEASE

AD

9 PTHactivity

Bone resorption

CIF multiplecystic

resorptive areas AD

abnormalsensitive

Tsenunca2t 1 Is Pog to witD

I PTHlevel

Supra valvular aortic stenosis

MR Crmentalretardation

Elfin facies

CIF of Hypercalcemia NI 8.5 10.5 Mgtdl

symptoms 11.6 12.0

mglde

128 mgldi

caliche mduef
cardiac arrest 19.8mgldl

Medicrofency coma

Evaluation of Hypercalcemia

S Cast 94

Is

do s PTH levels

cow

high
PTHrelated a

Malignancy

Is a vitD

urine cart Bone turnover

cow

High

Adenoma FHH

CAofPTH

Pxof Hypercalcemia

Mild Hypercalcemia a

ringldl Hydration
Severe Hypercalcemia I 15 Hydration t
Furosemide

mgldl t

calcitonin Rapid

1 Meet

Bisphosphonali 29 9

ms
effect

comes

i sarcoidosis

Roleof glucocorticoids

I a OHease action 2
Malignancy related

ECG shortening of 8T interval

Hypocalcemia

initial pathology

sPTHt

d absentthymusorparathyroid

causesPTHresistance
sense even
oppof0casemute cast as high PTH

lipolysis Feabinds scast

poas released buids cant

initial pathology Hyperparathyroidism

2

osteoclast

osteoblast

cart 1

cast

Afterparnthyroidectomy

ofosteoclasts stops

osteoblasts remain

He

is can taken by

bone

CIF are dueto muscle

irritability

paresthesias circumoral
ANM

d irritability

so Chovstek's
sign tap ant to ear NM twiteer
irritability

circum oral mrs

I carpal spasm inflationof Blood press

cuff to

Trousseau's 20mm above the patients systolic

sign for
BP 3 mins

Severe hypercalcemia seizures

carpopedal
broncho
spasm

spasm

laryngo spasm

Eca prolongation of QT interval arrhythmias

Torsades de Points

Diagnostic approach

s.ca2 Rule out low serum albumin

low albumin s cast 1

PTH

low
lovely High

1 1

vit D

Hyperparathyroidism deficiency

Is

5InIisi9tX

naainaiag.EE

Renal
failure

Correction

Factor

whenever serum albumin conc ti

corrected cast conc is calculated adding0.2 mm O8mqldl

to total cast level

forevery decrement mi

serum albumin of Ogldl

1

below the of
value 9.1gede

cart binds c albumin ref

e S Albumin 2.1

of s Ca't gfdl
T5

mgedl

2 0.8

corrected cast 7.5

9.1

Rs Symptoms

1 v t

Tetanyl Tetany 0

QT T QT Nn

H H

W Cast gluconate oral cast

witD

oral cart Maintainance

castgluconate 10.1 diluted in

50mi of Dextrose 5

0.9 l NS

IV over 5 ruins


0.9mmolL

NK 1.5 2 3mgldL

Hypomagnesemia mostignored electrolyteimbalance

check E toast

MICO aYtsYIuew
cpsoa.srdsje.g.eu
SI
creepsin cartpoop mgaairsfrom

dans

macechannelmute A

Gantu zu n n In Gilelmann Mg2Tloss more severe than

Barters

K targetaers

Mgmdiuresis

Daiei

baileemann

CIF due to 4 Cart induced

in by 1 Mga PTYresistance

i
i

Tetany

but see fmer

ECG QT T

K Mild 1 asymptomatic oral salts CUT02 1 OH

Mg

severe IV Mgeez

Use
of 1M
Mgs0g discouraged painful

deliver low quantityofMgm

largedose necrosis

Hyper Magnesemia

mee c of9mg2t

CIF due to smooth muscle relann property of angst

Is
VASODILATION
Hypotension
72mmolIL or
748mg1dL
NM Block t Deep tendon Reflex
c2mmolIL or asingidL I RF
ammogfin lotof
Icastinduced 9 0 PTH release
by
at serum level of 10mmolIL
Mg by
ASYSTOLE
ECG QT prolonged
PR ORS prolonged

Px 1 If IIBP IV NS fluids
2
If cast QTR Iv cartgluconate
3
If laxative abuse c
Mg2tcontainingdrugs
Cugatremains in art forlong time
1
givemyfreelaxative