Calcium Regulation and Disorders Quiz
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Questions and Answers

What defines mild hypercalcemia?

  • > 3.5 mmol/L
  • 2.6–3.0 mmol/L (correct)
  • < 2.2 mmol/L
  • 2.2–2.6 mmol/L
  • What is the corrected calcium formula based on serum calcium and albumin levels?

  • Serum Ca x (Patient Albumin / Normal Albumin)
  • Serum Ca - (Normal Albumin / Patient Albumin)
  • Serum Ca + 0.02 x (Normal Albumin – Patient Albumin) (correct)
  • Serum Ca - 0.02 x (Normal Albumin + Patient Albumin)
  • Which hormone is primarily responsible for regulating serum calcium levels?

  • Parathyroid hormone (PTH) (correct)
  • Insulin
  • Calcitonin
  • Cortisol
  • What is a life-threatening medical emergency related to calcium levels?

    <p>Severe hypercalcemia (A)</p> Signup and view all the answers

    How does parathyroid hormone (PTH) respond to hypocalcemia?

    <p>It is secreted to increase serum calcium levels. (A)</p> Signup and view all the answers

    Which of the following processes does not directly regulate calcium levels?

    <p>Liver metabolism (C)</p> Signup and view all the answers

    What is a cardinal symptom of hypercalcemia?

    <p>Nausea and vomiting (B)</p> Signup and view all the answers

    Why is it important to calculate the corrected calcium level?

    <p>It considers abnormal albumin levels that may misreport calcium. (A)</p> Signup and view all the answers

    What physiological response occurs in the case of hypocalcemia concerning renal function?

    <p>Increases calcium reabsorption in the distal tubule (B)</p> Signup and view all the answers

    Which of the following is NOT a symptom of hypercalcemia?

    <p>Seizures (D)</p> Signup and view all the answers

    What can be a complication of prolonged hypocalcemia regarding ECG changes?

    <p>QT prolongation (C)</p> Signup and view all the answers

    Which condition is associated with hypocalcemia and decreased PTH levels?

    <p>Autoimmune hypoparathyroidism (A)</p> Signup and view all the answers

    What characterizes Trousseau's sign?

    <p>Inflation of sphygmomanometer leads to hand spasm (D)</p> Signup and view all the answers

    What is a common cause of hypocalcemia with high PTH levels?

    <p>Osteoblastic metastases (C)</p> Signup and view all the answers

    Which statement describes a consequence of hypercalcemia on the musculoskeletal system?

    <p>Bone pain due to reduction in cortical bone mass (C)</p> Signup and view all the answers

    Which factor can contribute to secondary hyperparathyroidism due to vitamin D deficiency?

    <p>Reduced UV light exposure (A)</p> Signup and view all the answers

    Which condition is associated with acute hypocalcemia and can manifest as psychological symptoms?

    <p>Tetany (B)</p> Signup and view all the answers

    Which medication class is associated with causing hypocalcemia?

    <p>Bisphosphonates (D)</p> Signup and view all the answers

    In terms of renal effects, what condition is commonly associated with hypercalcemia?

    <p>Nephrolithiasis and acute kidney insufficiency (C)</p> Signup and view all the answers

    Which of these symptoms is specifically linked to chronic hypocalcemia?

    <p>Ectodermal changes (C)</p> Signup and view all the answers

    What is a consequence of hyperphosphatemia in relation to hypocalcemia?

    <p>Competitive binding of phosphate to calcium (B)</p> Signup and view all the answers

    Which of the following statements about acute pancreatitis and hypocalcemia is true?

    <p>It leads to precipitation of calcium soaps (A)</p> Signup and view all the answers

    What should be verified first when investigating hypercalcemia?

    <p>Corrected calcium levels (B)</p> Signup and view all the answers

    In chronic kidney disease, which vitamin D form is typically decreased?

    <p>1,25-dihydroxyvitamin D (D)</p> Signup and view all the answers

    What is a common gastrointestinal manifestation of hypercalcemia?

    <p>Constipation (A)</p> Signup and view all the answers

    What condition is primarily responsible for over 90% of cases of hypercalcemia?

    <p>Primary hyperparathyroidism (A)</p> Signup and view all the answers

    Which cardiovascular manifestation is associated with acute hypercalcemia?

    <p>Arrhythmia (A)</p> Signup and view all the answers

    Which of the following signs is indicative of neuromuscular excitability due to hypocalcemia?

    <p>Trousseau's sign (A)</p> Signup and view all the answers

    What effect does hypocalcemia have on cardiac action potential?

    <p>Prolongs it (D)</p> Signup and view all the answers

    Which of the following can lead to hypocalcemia?

    <p>Hypoparathyroidism (C)</p> Signup and view all the answers

    What is a potential cause of pancreatitis in patients with hypercalcemia?

    <p>Calcium deposition in the pancreatic duct (D)</p> Signup and view all the answers

    Which condition is NOT a differential diagnosis for hypercalcemia?

    <p>Nutritional deficiencies (B)</p> Signup and view all the answers

    What is a common characteristic of patients with hypercalcemia of malignancy compared to those with primary hyperparathyroidism?

    <p>They are usually more symptomatic from hypercalcemia. (D)</p> Signup and view all the answers

    Which of the following is NOT considered an aggravating factor for mild hypercalcemia?

    <p>Hyperhydration (D)</p> Signup and view all the answers

    What indicates a need for aggressive therapy in severe hypercalcemia?

    <p>Lethargy or stupor. (D)</p> Signup and view all the answers

    In managing moderate hypercalcemia, which statement is accurate regarding treatment urgency?

    <p>Asymptomatic individuals may not need immediate therapy. (A)</p> Signup and view all the answers

    What determines the urgency of therapy in cases of hypercalcemia?

    <p>The degree of hypercalcemia and rate of rise in serum calcium concentration. (A)</p> Signup and view all the answers

    What initial therapy is recommended for severe acute hypocalcemia?

    <p>Simultaneous intravenous isotonic saline and intravenous calcium therapy (A)</p> Signup and view all the answers

    In which case is intravenous calcium therapy not warranted as the initial treatment?

    <p>Asymptomatic patient with chronic stable hypocalcemia (A)</p> Signup and view all the answers

    What is typically the primary goal of treating chronic stable hypocalcemia in patients with CKD?

    <p>Correction of low circulating 1,25-dihydroxyvitamin D (C)</p> Signup and view all the answers

    What additional treatment is often required for patients with hypoparathyroidism or vitamin D deficiency?

    <p>Vitamin D administration (B)</p> Signup and view all the answers

    What is the primary focus in treating patients with concurrent hypocalcemia and hypomagnesemia?

    <p>Correcting hypomagnesemia first (A)</p> Signup and view all the answers

    How should symptoms of mildly symptomatic hypocalcemia with corrected serum calcium concentrations above 1.9 mmol/L be initially treated?

    <p>Oral calcium supplementation (A)</p> Signup and view all the answers

    What common condition can complicate the management of hypocalcemia?

    <p>Hypomagnesemia (A)</p> Signup and view all the answers

    What testing is crucial before confirming hypocalcemia treatment?

    <p>Verifying serum calcium with a corrected calcium level (D)</p> Signup and view all the answers

    Which statement is true regarding the management of mild hypercalcemia?

    <p>Patients should avoid factors that could worsen the condition, such as vitamin D supplements. (C)</p> Signup and view all the answers

    What is an important consideration for patients with moderate hypercalcemia?

    <p>Chronic moderate hypercalcemia can sometimes be asymptomatic without the need for urgent therapy. (D)</p> Signup and view all the answers

    Which symptom might indicate a need for aggressive therapy in severe hypercalcemia?

    <p>Lethargy and stupor (B)</p> Signup and view all the answers

    When considering the urgency of therapy for hypercalcemia, which factor is most crucial?

    <p>The degree of hypercalcemia and the rate of rise in serum calcium concentration. (C)</p> Signup and view all the answers

    In patients with hypercalcemia of malignancy, how does their condition typically compare to those with primary hyperparathyroidism?

    <p>They usually have higher calcium concentrations and more severe symptoms. (A)</p> Signup and view all the answers

    Which symptom is most likely associated with severe hypocalcemia?

    <p>Carpal spasm (A)</p> Signup and view all the answers

    What is a possible cardiac manifestation in hypocalcemia?

    <p>QT prolongation (C)</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of hypercalcemia?

    <p>Papilledema (B)</p> Signup and view all the answers

    Which of the following statements about Chvostek's sign is correct?

    <p>It involves tapping the facial nerve. (D)</p> Signup and view all the answers

    Which mechanism is primarily responsible for the symptoms observed in hypercalcemia?

    <p>Reduction in cortical bone mass. (B)</p> Signup and view all the answers

    What is the primary neurological sign associated with significant hypocalcemia?

    <p>Seizures (D)</p> Signup and view all the answers

    How does parathyroid hormone (PTH) influence calcium levels in the event of hypocalcemia?

    <p>Stimulates bone calcium resorption. (A)</p> Signup and view all the answers

    Which of the following gastrointestinal symptoms may indicate hypercalcemia?

    <p>Constipation (C)</p> Signup and view all the answers

    What is the primary role of parathyroid hormone (PTH) in calcium homeostasis?

    <p>To regulate bone turnover and calcium levels (A)</p> Signup and view all the answers

    Which of the following laboratory findings is indicative of mild hypercalcemia?

    <p>Serum calcium of 2.6 - 3.0 mmol/L (C)</p> Signup and view all the answers

    In which scenario is hypercalcemia considered a medical emergency?

    <p>When serum calcium levels exceed 3.5 mmol/L (C)</p> Signup and view all the answers

    What is a primary consequence of low serum albumin levels on calcium measurement?

    <p>Misleading normal calcium levels (D)</p> Signup and view all the answers

    What process is primarily responsible for the release of parathyroid hormone (PTH)?

    <p>Low serum calcium levels (A)</p> Signup and view all the answers

    Which of the following accurately describes the relationship between calcium and albumin in blood tests?

    <p>Normal calcium levels can be masked by low albumin (A)</p> Signup and view all the answers

    Which symptom is least likely to be associated with hypocalcemia?

    <p>Weight gain (D)</p> Signup and view all the answers

    Which principle is crucial in investigating calcium disorders?

    <p>Always calculate corrected calcium (D)</p> Signup and view all the answers

    What physiological mechanism causes myocardial dysfunction in hypocalcemia?

    <p>Calcium's role in excitation-contraction coupling (D)</p> Signup and view all the answers

    Which symptom is most closely associated with hyperexcitability of peripheral neurons due to hypocalcemia?

    <p>Tetany (C)</p> Signup and view all the answers

    What is a potential consequence of chronic hypercalcemia on the cardiovascular system?

    <p>Prolonged QT interval on ECG (B)</p> Signup and view all the answers

    Which condition is least likely to cause hypercalcemia due to increased bone resorption?

    <p>Familial hypocalciuric hypercalcemia (A)</p> Signup and view all the answers

    Which of the following conditions can lead to hypocalcemia due to insufficient parathyroid hormone secretion?

    <p>Hypoparathyroidism (A)</p> Signup and view all the answers

    What gastrointestinal manifestation is commonly associated with chronic hypercalcemia?

    <p>Nausea (B)</p> Signup and view all the answers

    Which of the following best describes a condition that directly leads to nephrocalcinosis?

    <p>Chronic hypercalcemia (D)</p> Signup and view all the answers

    What change is typically observed on an ECG in patients with acute hypercalcemia?

    <p>Shortened QT interval (C)</p> Signup and view all the answers

    Which condition is primarily associated with hypocalcemia and high levels of parathyroid hormone (PTH)?

    <p>Vitamin D deficiency (D)</p> Signup and view all the answers

    What condition can cause hypocalcemia due to an impairment in PTH secretion?

    <p>Sepsis (A)</p> Signup and view all the answers

    Which of the following drug classes is commonly associated with inducing hypocalcemia?

    <p>Bisphosphonates (C)</p> Signup and view all the answers

    In chronic kidney disease, what compound's decreased production leads to a form of hypocalcemia?

    <p>1,25-dihydroxyvitamin D (D)</p> Signup and view all the answers

    What is a potential risk associated with insufficient magnesium levels in conjunction with hypocalcemia?

    <p>PTH resistance (A)</p> Signup and view all the answers

    Which of the following could be a secondary cause of hypocalcemia due to excessive tissue breakdown?

    <p>Rhabdomyolysis (D)</p> Signup and view all the answers

    What underlying mechanism links acute pancreatitis to hypocalcemia?

    <p>Precipitation of calcium soaps (B)</p> Signup and view all the answers

    Which of the following conditions is characterized by infiltrative disease leading to hypocalcemia with decreased PTH?

    <p>Haemochromatosis (B)</p> Signup and view all the answers

    What is the primary treatment for severely symptomatic acute hypocalcemia?

    <p>Intravenous calcium therapy (D)</p> Signup and view all the answers

    In which situation is intravenous calcium therapy not considered as initial treatment?

    <p>Patients with chronic stable hypocalcemia showing mild symptoms (D)</p> Signup and view all the answers

    What is usually required in addition to calcium supplementation for patients with hypoparathyroidism?

    <p>Administration of vitamin D (B)</p> Signup and view all the answers

    What approach is suggested for patients with concurrent hypocalcemia and magnesium deficiency?

    <p>Correct hypomagnesemia first (A)</p> Signup and view all the answers

    Which of the following indicates the need for IV calcium infusion in mildly symptomatic hypocalcemia?

    <p>Failure of oral calcium to improve symptoms (C)</p> Signup and view all the answers

    What should be verified before investigating the cause of hypocalcemia?

    <p>Serum calcium result with corrected calcium level (D)</p> Signup and view all the answers

    What is the initial management strategy for chronic stable hypocalcemia in patients with chronic kidney disease (CKD)?

    <p>Correct hyperphosphatemia and low vitamin D levels (B)</p> Signup and view all the answers

    What constitutes the main focus in the treatment of severe acute hypocalcemia?

    <p>Rapid correction of calcium levels (A)</p> Signup and view all the answers

    Flashcards

    Hypercalcemia

    A condition where the level of calcium in the blood is higher than normal. It can be mild, moderate or severe, with severe hypercalcemia being a medical emergency.

    Hypocalcemia

    A condition where the level of calcium in the blood is lower than normal.

    Calcium Homeostasis

    The process by which the body maintains the correct balance of calcium levels in the blood. This involves the interplay of three main processes: bone turnover (building and breaking down bone), intestinal absorption (taking calcium from food) and renal excretion (removing calcium from the body through urine).

    Parathyroid Hormone (PTH)

    A hormone produced by the parathyroid glands located near the thyroid gland. It plays a major role in regulating calcium levels in the blood. When calcium levels are low, PTH is released to increase calcium levels. When calcium levels are high, PTH release is suppressed.

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    Vitamin D

    A form of vitamin D that is crucial for calcium homeostasis. Along with PTH, vitamin D helps regulate calcium levels by increasing calcium absorption from the gut.

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    Bone Turnover

    The process of building new bone and breaking down old bone. This constant turnover is essential for maintaining bone health and regulating calcium levels.

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    Intestinal Absorption of Calcium

    The process by which calcium from food is absorbed into the bloodstream through the intestines.

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    Renal Excretion of Calcium

    The process by which calcium is removed from the body through urine by the kidneys.

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    Tetany

    Characterized by involuntary muscle spasms, especially in the hands and feet.

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    Chvostek's Sign

    A physical examination finding where tapping on the facial nerve causes twitching of the facial muscles.

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    Trosseau's Sign

    A physical examination finding where inflating a blood pressure cuff above systolic pressure for 3 minutes causes involuntary contraction of the hand and wrist.

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    Nephrolithiasis

    A medical term referring to the formation of kidney stones.

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    Reduced Bone Mass

    A decrease in the density of bone tissue, making it more prone to fractures.

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    QTc Prolongation

    A prolongation of the QT interval on an electrocardiogram (ECG), which can lead to dangerous heart rhythm abnormalities.

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    Nephrocalcinosis

    The condition where calcium deposits form in the kidney tissue, potentially leading to kidney damage. Often associated with hypercalcemia.

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    Tertiary Hyperparathyroidism

    A syndrome characterized by high levels of calcium in the blood due to underactive parathyroid glands, commonly seen in patients who have undergone thyroid surgery.

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    Hypercalcemia Prevention

    Involves regular medication review and addressing the root cause of hypercalcemia.

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    Hypercalcemia Principles

    The severity of hypercalcemia and how quickly calcium levels rise determine the symptoms and need for urgent treatment.

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    Mild Hypercalcemia Management

    People with mild or no symptoms from high calcium levels don't need immediate treatment. However, avoiding factors that can worsen it is crucial.

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    Moderate Hypercalcemia Management

    Individuals with chronic moderate hypercalcemia and no significant symptoms may not need immediate therapy but must avoid aggravating factors. However, a sudden increase in calcium levels could require immediate intervention.

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    Severe Hypercalcemia Management

    People with serious symptoms or high calcium levels require aggressive medical attention.

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    Vitamin D Deficiency Hypocalcemia

    Hypocalcemia with high PTH levels, caused by a reduced ability to absorb calcium from the gut due to insufficient vitamin D. This can be due to low dietary intake, limited sun exposure, or impaired activation in the liver and kidneys.

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    Chronic Kidney Disease Hypocalcemia

    Hypocalcemia with high PTH levels, caused by the kidneys' inability to produce enough activated vitamin D. This typically occurs in the late stages of kidney disease.

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    Hyperphosphatemia Hypocalcemia

    Hypocalcemia with high PTH levels, caused by excessive phosphate in the blood. This can be caused by kidney disease or rapid breakdown of tissues, like in rhabdomyolysis or tumor lysis syndrome.

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    Osteoblastic Metastases Hypocalcemia

    Hypocalcemia with high PTH levels, caused by the deposition of calcium into new bone formation around a tumor.

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    Acute Pancreatitis Hypocalcemia

    Hypocalcemia with high PTH levels, caused by calcium soaps precipitating in the abdominal cavity.

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    Sepsis, Severe Illness, Surgery Hypocalcemia

    Hypocalcemia with high PTH levels, caused by a combination of factors including impaired PTH secretion, reduced calcitriol production, and decreased sensitivity to PTH in the body.

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    Hypomagnesemia Hypocalcemia

    Hypocalcemia with high PTH levels, caused by a deficiency of magnesium, which can lead to resistance to PTH.

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    Hypoparathyroidism Hypocalcemia

    Hypocalcemia with low PTH levels caused by the parathyroid glands malfunctioning. This can be caused by surgery, autoimmune disorders, or genetic conditions.

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    Acute Hypocalcemia

    Severe hypocalcemia, with symptoms like muscle spasms, seizures, and heart problems.

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    IV Calcium Therapy

    Initial treatment for severe acute hypocalcemia, quickly boosting calcium levels.

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    Mild Hypocalcemia

    Mild hypocalcemia with symptoms like tingling or numbness.

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    Oral Calcium Supplementation

    Treatment for mild hypocalcemia, usually with oral calcium supplements.

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    Hypomagnesemia

    A condition where there is a deficiency of magnesium in the blood.

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    Hypomagnesemia's Impact on Hypocalcemia

    Hypomagnesemia should be corrected before treating hypocalcemia, as it can interfere with calcium regulation.

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    Intestinal Calcium Absorption

    The process of absorbing calcium from food into the bloodstream via the intestines.

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    Renal Calcium Excretion

    The process of removing excess calcium from the body through urine by the kidneys.

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    What is the role of parathyroid hormone (PTH) in calcium homeostasis?

    Parathyroid hormone (PTH) plays a crucial role in maintaining calcium homeostasis. When calcium levels drop, PTH is released, triggering a cascade of actions to restore normal levels.

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    What is tetany and how is it related to hypocalcemia?

    Hypocalcemia, or low calcium levels, can trigger tetany - a condition marked by involuntary muscle spasms. This is due to increased neuromuscular excitability caused by the low calcium levels.

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    What is Trosseau's sign and how is it related to hypocalcemia?

    Trosseau's sign is a clinical manifestation of hypocalcemia where inflating a blood pressure cuff above systolic pressure for 3 minutes causes involuntary contraction of the hand and wrist (carpal spasm).

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    What is Chvostek's sign and how is it related to hypocalcemia?

    Chvostek's sign is another clinical sign of hypocalcemia where tapping on the facial nerve anterior to the ear causes ipsilateral contraction of facial muscles, which can be a twitching lip or a spasm of all facial muscles.

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    How does hypercalcemia affect the electrocardiogram (ECG)?

    Hypercalcemia, or high calcium levels, can lead to a shortened QT interval on an electrocardiogram (ECG). This can progress to complete AV nodal block and cardiac arrest.

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    How does hypocalcemia affect the electrocardiogram (ECG)?

    Hypocalcemia can lead to QT prolongation on an ECG, which can progress to Torsades de pointes and cardiac arrest.

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    What are the common symptoms of hypercalcemia?

    Hypercalcemia often presents with symptoms summarized by the mnemonic "bones, stones, abdominal moans, and psychiatric groans."

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    What are the common symptoms of hypocalcemia?

    Hypocalcemia can lead to a variety of symptoms, depending on the severity and duration, including tetany, seizures, psychological symptoms, and cardiac manifestations.

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    What is hypercalcemia?

    Hypercalcemia is a condition where the level of calcium in the blood is higher than normal. It can be caused by several factors like overactive parathyroid glands (primary hyperparathyroidism), cancer (malignancy), or excessive vitamin D intake. Severe hypercalcemia is a medical emergency.

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    What is hypocalcemia?

    Hypocalcemia is the opposite of hypercalcemia, meaning the level of calcium in the blood is lower than normal. This can happen due to underactive parathyroid glands (hypoparathyroidism), vitamin D deficiency, or kidney problems.

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    What is Tetany?

    Tetany is a condition characterized by muscle spasms, often in the hands and feet. It's a common symptom of hypocalcemia and is caused by increased nerve excitability due to low calcium levels.

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    What are Trousseau's and Chvostek's signs?

    Trousseau's sign and Chvostek's sign are physical exam findings that can indicate hypocalcemia. Trousseau's is when inflating a blood pressure cuff causes hand spasms, while Chvostek's is when tapping the face causes facial muscle twitching.

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    How is hypercalcemia related to kidney stones?

    Nephrolithiasis, also known as kidney stones, can occur due to chronic hypercalcemia. This happens because high calcium levels in the bloodstream can lead to calcium crystal formation in the kidneys, eventually forming stones.

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    How does hypercalcemia affect the heart?

    Hypercalcemia can affect the cardiovascular system by shortening the heart's electrical activity (seen as a shortened QT interval on an ECG). Severe hypercalcemia can cause irregular heartbeats (arrhythmias). In the long term, hypercalcemia can lead to heart valve problems, coronary artery disease, and heart muscle damage.

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    How does hypocalcemia affect the heart?

    Hypocalcemia can cause prolonged QT intervals on an ECG, which can lead to dangerous heart rhythm abnormalities. This is because calcium plays a crucial role in heart muscle contraction, and low levels can disrupt this process.

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    What are some causes of hypercalcemia?

    While primary hyperparathyroidism is a major cause of hypercalcemia, other conditions like cancer, excessive vitamin D, kidney disease, and dehydration can also lead to high calcium levels in the blood.

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    Hypercalcemia of Malignancy vs. Primary Hyperparathyroidism

    Hypercalcemia of malignancy is usually more severe with higher calcium levels and more symptoms compared to primary hyperparathyroidism.

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    Study Notes

    Calcium Disorders Diagnosis and Management

    • Calcium disorders encompass hypercalcemia and hypocalcemia
    • Hypercalcemia is defined as a corrected serum calcium level above 2.6 mmol/L
    • Mild hypercalcemia ranges from 2.6-3.0 mmol/L
    • Moderate hypercalcemia ranges from 3.0-3.5 mmol/L
    • Severe hypercalcemia is greater than 3.5 mmol/L
    • Corrected calcium calculation: Serum Ca + 0.02 x (Normal Albumin – Patient Albumin)
    • Units: Calcium in mmol/L & albumin in g/L
    • Hypocalcemia is defined as a corrected serum calcium level below 2.2 mmol/L

    Calcium Homeostasis

    • Parathyroid hormone (PTH) regulates serum calcium levels
    • Vitamin D plays a crucial role in calcium regulation
    • Calcium homeostasis is controlled by three key processes: bone turnover, intestinal absorption, and renal excretion
    • PTH is secreted by the four parathyroid glands, in response to low calcium levels. PTH increases calcium resorption from bone, enhances calcium reabsorption in the distal tubule, and increases intestinal calcium absorption mediated by increased renal production of 1,25-dihydroxyvitamin D.

    Hypercalcemia Symptoms and Signs

    • Hypercalcemia can be asymptomatic at times
    • The mnemonic "bones, stones, abdominal moans, and psychiatric groans" helps remember the symptoms.
    • Bones: bone pain, pathological fractures
    • Stones: kidney stones (abdominal pain, haematuria),
    • Abdominal: abdominal pain, nausea, vomiting, constipation, pancreatitis
    • Psychiatric: confusion, hallucinations, lethargy, depression, other: sluggish reflexes, polydipsia, polyuria, palpitations, ECG: shortened QT interval - progressing to AV nodal block, cardiac arrest

    Hypocalcemia Symptoms and Signs

    • Hypocalcemia can be asymptomatic, and symptoms depend on severity and acuity.
    • Acute symptoms can include tetany, papilledema, seizures, psychological symptoms, cardiac manifestations (hypotension, heart failure, arrhythmias)
    • Chronic symptoms can include ectodermal and dental changes, cataracts, basal ganglia calcification, and extrapyramidal disorders.
      • Additional signs include neuromuscular irritability (mild paraesthesia, muscle cramping), severe carpopedal spasm, laryngospasm, seizures.
      • Additional signs include: Trosseau's sign (spasm after inflating blood pressure cuff), Chvostek's sign.
      • ECG prolongation can occur (Torsades de pointes,Cardiac Arrest).

    Hypercalcemia Differential Diagnoses

    • Over 90% of hypercalcemia cases are due to primary hyperparathyroidism or malignancy
    • Other causes include malignancy (myeloma, bone metastases, paraneoplastic syndromes), excess vitamin D, renal disease, medications (lithium, thiazide diuretics), familial hypocalciuric hypercalcemia, and dehydration. Sarcoidosis, tuberculosis are also possible causes

    Hypocalcemia Differential Diagnoses

    • Hypocalcemia can arise when PTH secretion is insufficient (hypoparathyroidism), or if other factors cause low calcium like Vitamin D deficiency.
    • Additional causes of hypocalcemia with high PTH include: vitamin D deficiency, chronic kidney disease, hyperphosphatemia, osteoblastic metastases, acute pancreatitis, sepsis, severe illness, surgery, and hypomagnesemia.
    • Other causes of hypocalcemia with low PTH include: drugs (bisphosphonates, denosumab, calcium chelating medication, chemotherapy), postsurgical hypoparathyroidism, autoimmune disorders, familial hypocalcemia, infiltrative disorders, and metastatic disease.

    Investigation and Management Principles

    • Investigation and management of calcium disorders involve verifying serum calcium levels with corrected calcium values, determining if PTH is elevated, normal, or reduced, and addressing underlying causes.
    • Treatment approaches are tailored to the severity and underlying cause of the disorder.

    Resources

    • UpToDate
    • Geeky Medics

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    Test your knowledge on mild hypercalcemia, its symptoms, and the hormones involved in calcium regulation. This quiz covers critical concepts related to calcium levels, including physiological responses and complications of disorders. Perfect for students in advanced biology or medical studies.

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