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Which of the following is NOT a common etiology of shock in children?
Which of the following is NOT a common etiology of shock in children?
In hypovolemic shock, what is the primary pathophysiological change that occurs?
In hypovolemic shock, what is the primary pathophysiological change that occurs?
What characterizes distributive shock?
What characterizes distributive shock?
Which of the following conditions would likely lead to septic shock?
Which of the following conditions would likely lead to septic shock?
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Which of the following clinical manifestations might indicate myocardial depression in shock?
Which of the following clinical manifestations might indicate myocardial depression in shock?
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What occurs during obstructive shock?
What occurs during obstructive shock?
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In the context of shock, which type results from systemic histamine release?
In the context of shock, which type results from systemic histamine release?
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Which feature is common in both septic and anaphylactic shock?
Which feature is common in both septic and anaphylactic shock?
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Which statement regarding cardiogenic shock is correct?
Which statement regarding cardiogenic shock is correct?
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How does hypovolemic shock typically present in infants?
How does hypovolemic shock typically present in infants?
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What is a common clinical manifestation of septic shock?
What is a common clinical manifestation of septic shock?
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Which treatment focuses are associated with neurogenic shock?
Which treatment focuses are associated with neurogenic shock?
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What is a potential complication of pediatric burns leading to shock?
What is a potential complication of pediatric burns leading to shock?
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Which of the following is a characteristic finding in obstructive shock?
Which of the following is a characteristic finding in obstructive shock?
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What vital sign abnormality is most commonly seen in hypoVolemic shock?
What vital sign abnormality is most commonly seen in hypoVolemic shock?
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In patients experiencing distributive shock, what is the role of vasopressors?
In patients experiencing distributive shock, what is the role of vasopressors?
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What is a primary focus in the treatment of anaphylactic shock?
What is a primary focus in the treatment of anaphylactic shock?
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Which patient symptom indicates severe dehydration in a child experiencing hypovolemic shock?
Which patient symptom indicates severe dehydration in a child experiencing hypovolemic shock?
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Which of the following is NOT a characteristic of cardiogenic shock?
Which of the following is NOT a characteristic of cardiogenic shock?
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What clinical manifestation is characteristic of hypovolemic shock?
What clinical manifestation is characteristic of hypovolemic shock?
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Which symptom is indicative of septic shock?
Which symptom is indicative of septic shock?
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What is a primary cause of distributive shock?
What is a primary cause of distributive shock?
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Which of the following does NOT characterize Beck's Triad in the context of cardiac tamponade?
Which of the following does NOT characterize Beck's Triad in the context of cardiac tamponade?
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What complication is commonly associated with distributive shock?
What complication is commonly associated with distributive shock?
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What is a consequence of impaired cellular metabolism during shock?
What is a consequence of impaired cellular metabolism during shock?
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In hypovolemic shock, which physiological response occurs first?
In hypovolemic shock, which physiological response occurs first?
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Which of the following is a classic clinical manifestation of shock?
Which of the following is a classic clinical manifestation of shock?
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How does cardiac tamponade affect cardiac output?
How does cardiac tamponade affect cardiac output?
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What happens to the afterload during hypovolemic shock?
What happens to the afterload during hypovolemic shock?
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Which condition describes the state of shock where blood flow is redirected due to leaky capillaries?
Which condition describes the state of shock where blood flow is redirected due to leaky capillaries?
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Which neurohormonal response occurs during cardiogenic shock to help maintain blood pressure?
Which neurohormonal response occurs during cardiogenic shock to help maintain blood pressure?
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What is the primary treatment focus for obstructive shock?
What is the primary treatment focus for obstructive shock?
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Which clinical manifestation is most likely observed in infants experiencing shock?
Which clinical manifestation is most likely observed in infants experiencing shock?
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What characterizes severe dehydration in children with hypovolemic shock?
What characterizes severe dehydration in children with hypovolemic shock?
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What physiological change occurs during obstructive shock that leads to reduced cardiac output?
What physiological change occurs during obstructive shock that leads to reduced cardiac output?
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In which type of shock is the loss of sympathetic tone significant?
In which type of shock is the loss of sympathetic tone significant?
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Which vital sign change is indicative of impending cardiovascular collapse in hypovolemic shock?
Which vital sign change is indicative of impending cardiovascular collapse in hypovolemic shock?
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Which of the following is a primary cause of hypovolemic shock in children?
Which of the following is a primary cause of hypovolemic shock in children?
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In a child experiencing shock, which condition is most likely to result in progressive heart failure?
In a child experiencing shock, which condition is most likely to result in progressive heart failure?
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What is a common complication in children with burn injuries related to shock?
What is a common complication in children with burn injuries related to shock?
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Which type of shock is primarily characterized by inappropriate vasodilation?
Which type of shock is primarily characterized by inappropriate vasodilation?
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What is a primary concern regarding the physiological impact of congenital heart defects in obstructive shock?
What is a primary concern regarding the physiological impact of congenital heart defects in obstructive shock?
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What is the primary mechanism leading to myocardial depression during shock?
What is the primary mechanism leading to myocardial depression during shock?
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Which manifestation might indicate the presence of septic shock in a child?
Which manifestation might indicate the presence of septic shock in a child?
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In pediatric patients, what symptom can signify hypoglycemia during shock?
In pediatric patients, what symptom can signify hypoglycemia during shock?
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What role does the accumulation of microembolisms play in the development of shock?
What role does the accumulation of microembolisms play in the development of shock?
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Which factor is least likely to contribute to electrolyte imbalances in achieving shock?
Which factor is least likely to contribute to electrolyte imbalances in achieving shock?
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What key factor differentiates obstructive shock from other types of shock?
What key factor differentiates obstructive shock from other types of shock?
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In children, which of the following conditions is least likely to lead to shock?
In children, which of the following conditions is least likely to lead to shock?
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What is the primary issue in obstructive shock?
What is the primary issue in obstructive shock?
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In pediatric patients, which factor typically complicates the presentation of shock?
In pediatric patients, which factor typically complicates the presentation of shock?
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What underlying mechanism is primarily involved in the development of pulmonary embolism as an obstructive shock?
What underlying mechanism is primarily involved in the development of pulmonary embolism as an obstructive shock?
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Which clinical manifestation is least likely to be associated with obstructive shock?
Which clinical manifestation is least likely to be associated with obstructive shock?
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In the context of pediatric shock, which of the following symptoms is most critical to monitor?
In the context of pediatric shock, which of the following symptoms is most critical to monitor?
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What is a common misconception about hypovolemic shock?
What is a common misconception about hypovolemic shock?
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Which condition is often associated with hypocalcemia in patients experiencing shock?
Which condition is often associated with hypocalcemia in patients experiencing shock?
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Which of the following statements regarding obstructive shock is accurate?
Which of the following statements regarding obstructive shock is accurate?
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During hypovolemic shock, which neurohormonal response is critical for maintaining blood pressure?
During hypovolemic shock, which neurohormonal response is critical for maintaining blood pressure?
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Which symptom might indicate the physiological effects of distributive shock in a child?
Which symptom might indicate the physiological effects of distributive shock in a child?
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What characterizes the hypodynamic state in shock progression?
What characterizes the hypodynamic state in shock progression?
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Which of the following is a potential consequence of prolonged hypocalcemia?
Which of the following is a potential consequence of prolonged hypocalcemia?
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In shock states, which physiological change is indicative of a shift to anaerobic metabolism?
In shock states, which physiological change is indicative of a shift to anaerobic metabolism?
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Study Notes
Hypocalcemia: Acute Care Considerations
- Head/Neck Surgeries can cause hypocalcemia
- Autoimmune diseases can lead to hypocalcemia
- Parathyroid cancer (or treatment) can cause hypocalcemia
- Heavy metal exposure (e.g., copper) can contribute to the condition
- Magnesium abnormalities can impact calcium homeostasis
- Multiple drug transfusions (e.g., citrate-containing solutions) can cause hypocalcemia
- Drugs such as < 8.8 dL/L calcium.
- Ionized Ca < 4.7 mg/dL is a marker for hypocalcemia
- Chronic hypocalcemia is often caused by hypoparathyroidism or vitamin D deficiency
- Patients may be asymptomatic, making diagnosis challenging.
- Primary hypoparathyroidism means the parathyroid gland does not adequately produce parathyroid hormone (PTH)
- Vitamin D deficiency also hinders calcium regulation
Hypoparathyroidism, Serum PTH, 25-hydroxyvitamin D and Alkaline Phosphatase
- Serum PTH levels are low in hypoparathyroidism
- Vitamin D deficiency shows high PTH levels
- PTH resistance shows very high PTH levels
- High vitamin D resistance levels can also cause high PTH levels
- Renal disease is associated with high PTH levels, but may show normal or low 25-hydroxyvitamin D levels
- Hypomagnesemia: normal PTH and normal 25-hydroxyvitamin D
- Metastatic disease is associated with elevated PTH levels and normal or low vitamin D
Hypocalcemia: Clinical Presentation
- Paresthesias (tingling/numbness), often around the mouth is a symptom of low calcium
- Cramping and muscle spasms (including laryngospasm) may occur
- Altered mental status, including confusion and seizures, can occur
- Prolonged QT intervals may indicate issues in the electrical activity of the heart
- Chvostek's sign (facial twitching response to a tap) and Trousseau's sign (carpopedal spasms with a blood pressure cuff) may be observed
- Slowing of the central nervous system in hypercalcemia is characteristic, but in hypocalcemia, we see symptoms that show increased CNS activity (seizures, tetany)
Diagnostic Approach to Hypocalcemia
- Begin by checking the parathyroid hormone (PTH) level
- Evaluate vitamin D status (25-hydroxyvitamin D)
- Consider nutritional deficiencies or renal insufficiency/resistance
- Look for underlying causes, such as medication side effects or other conditions
Corrected Calcium
- Serum PTH is the most reliable indicator of calcium levels, especially in hypercalcemia context.
- Ionized calcium is considered a more reliable measure of biologically active calcium compared to total serum calcium, particularly when individuals have abnormal levels or malnutrition/cancer issues.
- Correcting serum calcium for albumin levels (corrected calcium) gives a value for serum calcium accounting for the bound portion of calcium to protein/albumin as a measure of active calcium
- The diagnostic approach needs a check on comprehensive chemistry (liver and kidney function) to rule out some other possible causes such as nutritional deficiences, magnesium issues and also, check on ionized calcium
Summary (Hypocalcemia)
- Calcium is crucial for many bodily functions
- Indications of abnormalities in calcium regulation need to be addressed with consideration of other factors, like magnesium, phosphate and renal/liver function
- PTH is the key in assessing the cause of hypocalcemia
- Correcting serum calcium for albumin is necessary before interpreting the results
- If giving IV calcium supplementation, safe and reliable access is needed (preferably central lines)
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Description
This quiz covers the clinical aspects of hypocalcemia, including causes such as head/neck surgeries, autoimmune diseases, and magnesium abnormalities. It also discusses how conditions like hypoparathyroidism and vitamin D deficiency contribute to calcium homeostasis disruptions. Test your knowledge on diagnosis and management of hypocalcemia in acute care settings.
