Hypocalcemia and Hypercalcemia Quiz

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Questions and Answers

What is a characteristic of hypocalcemia associated with low PTH levels?

Autoimmune hypoparathyroidism (correct)

Chronic kidney disease

Acute pancreatitis

Vitamin D deficiency

Which condition could lead to hypocalcemia with high PTH levels due to inadequate vitamin D activation?

Hypomagnesemia

Sepsis

Rhabdomyolysis

Chronic kidney disease (correct)

Which of the following is NOT a cause of hypocalcemia with high PTH?

Calcium chelation therapy (correct)

Osteoblastic metastases

Severe illness

Hypomagnesemia

How does magnesium influence parathyroid hormone (PTH) activity?

Reduces PTH secretion and causes resistance Signup and view all the answers

What is the most common cause of hypercalcemia?

Primary hyperparathyroidism Signup and view all the answers

Which of the following conditions may lead to acute hypocalcemia due to tissue breakdown?

Hyperphosphatemia Signup and view all the answers

In patients with low serum calcium, what subsequent test is essential to determine the cause?

PTH levels Signup and view all the answers

Which statement accurately describes the effect of bisphosphonates on calcium levels?

They can cause hypocalcemia through reduced bone resorption Signup and view all the answers

What is defined as hypercalcemia?

Corrected serum calcium of > 2.6 mmol/L Signup and view all the answers

Which processes are involved in the regulation of calcium levels in the body?

Bone turnover, intestinal absorption, renal excretion Signup and view all the answers

What triggers the secretion of parathyroid hormone (PTH)?

Decreased serum calcium levels Signup and view all the answers

Which of the following is a clinical tip regarding calcium measurement?

Corrected calcium accounts for variations in albumin levels Signup and view all the answers

What level of corrected serum calcium is classified as severe hypercalcemia?

Greater than 3.5 mmol/L Signup and view all the answers

Which condition has a corrected serum calcium of less than 2.2 mmol/L?

Mild hypocalcemia Signup and view all the answers

Which of the following statements correctly reflects the relationship between PTH, calcium, and vitamin D?

PTH, calcium, and vitamin D interact, with changes in one affecting the others. Signup and view all the answers

What is the primary function of the parathyroid glands related to calcium?

To control the secretion of PTH in response to calcium levels Signup and view all the answers

What is the primary reason patients with hypercalcemia of malignancy are more symptomatic than those with primary hyperparathyroidism?

Higher rates of serum calcium concentration. Signup and view all the answers

Which of the following is NOT advisable for a patient with mild hypercalcemia?

Regular medication review. Signup and view all the answers

In patients with moderate hypercalcemia, what influences the need for immediate therapy?

Rate of rise in serum calcium concentration. Signup and view all the answers

What typically necessitates aggressive therapy in cases of severe hypercalcemia?

Symptoms such as lethargy or stupor. Signup and view all the answers

Which of the following factors could potentially exacerbate mild hypercalcemia?

Calcium supplements. Signup and view all the answers

What is the primary cause of polyuria related to hypercalcemia?

Decreased concentrating ability in the distal tubule Signup and view all the answers

Which gastrointestinal symptom is commonly associated with hypocalcemia?

Anorexia Signup and view all the answers

In the context of chronic hypercalcemia, how is myocardial action potential affected?

It is shortened Signup and view all the answers

What is a potential cardiovascular consequence of longstanding hypercalcemia?

Thickening of heart valves Signup and view all the answers

What neurological symptom is characteristic of hypocalcemia?

Tetany Signup and view all the answers

Which of the following conditions is NOT a common cause of hypercalcemia?

Hypoparathyroidism Signup and view all the answers

Which of the following signs indicates increased neuromuscular excitability due to hypocalcemia?

Trousseau's sign Signup and view all the answers

What is a potential cause of seizures in patients with hypocalcemia?

Prolonged QT syndrome Signup and view all the answers

What is the primary hormonal response to hypocalcemia?

Increased secretion of parathyroid hormone (PTH) Signup and view all the answers

Which symptom is NOT associated with hypercalcemia?

Carpopedal spasm Signup and view all the answers

What effect does PTH have on renal function during hypocalcemia?

Stimulates distal tubule calcium reabsorption Signup and view all the answers

Which sign indicates neuromuscular irritability due to hypocalcemia?

Trousseau’s sign Signup and view all the answers

How does severe hypercalcemia primarily affect the kidneys?

Can lead to kidney stones and acute insufficiency Signup and view all the answers

What is a common psychiatric symptom of hypercalcemia?

Depression Signup and view all the answers

Which veterinary sign results from irritability of the facial nerve during hypocalcemia?

Chvostek’s sign Signup and view all the answers

In what way does chronic hypocalcemia manifest in the body?

Cataracts and dental changes Signup and view all the answers

What is the initial therapy recommended for severe acute hypocalcemia?

Administration of intravenous calcium therapy Signup and view all the answers

In which scenario is intravenous calcium therapy not warranted as initial therapy?

In patients with chronic stable hypocalcemia with mild symptoms Signup and view all the answers

What is the primary goal in managing chronic stable hypocalcemia in patients with chronic kidney disease (CKD)?

Correction of hyperphosphatemia and low circulating vitamin D Signup and view all the answers

Which symptom indicates the need for immediate intravenous calcium therapy in severe acute hypocalcemia?

Bronchospasm and decreased cardiac function Signup and view all the answers

What additional treatment is often required when managing hypocalcemia caused by hypoparathyroidism or vitamin D deficiency?

Administration of vitamin D Signup and view all the answers

Concurrent hypomagnesemia in a hypocalcemic patient should be corrected because:

It is required to effectively treat hypocalcemia Signup and view all the answers

What is a necessary step before considering the correction of calcium levels?

Verifying the serum calcium result with a corrected calcium level Signup and view all the answers

Which of the following statements is incorrect about the management of hypocalcemia?

Chronic hypocalcemia requires immediate intravenous calcium infusion. Signup and view all the answers

Study Notes

Calcium Disorders

Diagnosis and management of calcium disorders is the focus of the study.
RCSI (Royal College of Surgeons in Ireland) developed the materials.

Learning Outcomes

The learning outcomes help guide the study.
Students will define hypercalcemia and hypocalcemia.
Students will explain the pathophysiology of both conditions.
Students will identify cardinal symptoms and signs of both conditions.
Students will explain the cause of each symptom and sign in each condition.
Students will identify the differential diagnosis for both conditions.
Students will outline the principles for investigating and managing these disorders.

Learning Outcome 1

Hypercalcemia is a serum calcium level greater than 2.6 mmol/L.
Hypocalcemia is a serum calcium level less than 2.2 mmol/L.
Corrected calcium levels account for albumin levels.

Learning Outcome 2

Calcium homeostasis is regulated by parathyroid hormone (PTH) and vitamin D.
Calcium regulation occurs through: bone turnover, intestinal absorption and renal excretion.

Learning Outcome 2 (Continued)

PTH is secreted by the parathyroid glands stimulated by low calcium levels in the blood.
PTH increases bone resorption, intestinal absorption and reduces calcium loss in the urine to increase calcium in the blood.

Learning Outcome 3

Symptoms and signs of hypercalcemia might be asymptomatic, include bone pain, pathological fractures, kidney stones, and gastrointestinal issues like abdominal pain, nausea, vomiting, constipation and pancreatitis, as well as psychological symptoms like confusion and lethargy.

Learning Outcome 4 (continued)

In hypocalcemia symptoms might be asymptomatic, include acute symptoms like tetany, papilledema and seizures, and chronic symptoms like ectodermal changes, cataracts, basal ganglia calcification and extrapyramidal disorders.

Learning Outcome 4(continued)

Symptoms in hypercalcemia are caused by the increase in calcium levels affecting bone, muscle contraction and function, nervous system function, coagulation cascades and intracellular signaling mechanisms.
Symptoms in hypocalcemia result from the decrease in calcium levels leading to neuromuscular excitability, affecting nerve function and causing muscle cramps, spasm and tetany, as well as cardiac manifestations.

Learning Outcome 5

Hypercalcemia differentials: Primary hyperparathyroidism, malignancy, vitamin D excess (supplements, sarcoidosis, tuberculosis), renal disease, drugs (lithium, thiazide diuretics), familial hypocalciuric hypercalcemia, and dehydration.
Hypocalcemia differentials: Hypoparathyroidism, vitamin D deficiency, postsurgical, autoimmune hypoparathyroidism, inherited disorders like familial hypocalcemia, infiltrative disorders (haemochromatosis, Wilson's disease), and metastatic diseases.
(Further factors for hypocalcemia: Vitamin D deficiency, chronic kidney disease, hyperphosphatemia, osteoblastic metastases and acute pancreatitis)

Learning Outcome 6

Investigation and management of calcium disorders need to consider underlying causes like drugs, kidney disease or even genetic predisposition.
The investigation should involve evaluating PTH levels and consider imaging and other tests.
Treatment varies depending on the specific cause and severity of the condition.

Hypercalcemia Investigation

Initial steps include verifying serum calcium and measuring PTH.

Hypocalcemia Investigation

Testing serum calcium and measuring PTH are initial steps.
Further tests to investigate for underlying causes.

Hypercalcemia Management

Prevention involves regularly reviewing medications and treating underlying conditions.
Management is based on the severity and underlying cause, with mild cases potentially needing only monitoring and moderate cases avoiding exacerbating factors.
Severe cases need aggressive therapy including IV isotonic saline, calcitonin, and bisphosphonates.

Hypocalcemia Management

Prevention includes regularly reviewing medications and treating underlying causes
Treatment varies based on severity, with severe cases requiring significant interventions like IV calcium while milder cases can involve oral calcium.

Additional Key Points

Corrected calcium levels are vital to account for varying albumin levels.
Serum calcium levels should be verified with corrected calcium levels.
The underlying causes of either condition need to be addressed.
The severity of the condition dictates immediate response and treatment choices.

Resources

UpToDate
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Description

Test your knowledge on hypocalcemia and hypercalcemia, including their causes, associated conditions, and the role of parathyroid hormone (PTH). This quiz covers essential clinical concepts and laboratory assessments related to calcium regulation in the body.