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What is hypocalcemia?
<2.1(?)
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What causes hypocalcemia?
- Chronic renal failure (via decreased production of Vit D)
- Hypoparathyroidism
- Vit D deficiency
- Calcium sequestration due to: pancreatitis, massive blood transfusions (>6 units), rhabdo, tumor lysis syndrome
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What are sx of hypocalcemia?
- Perioral paresthesias
- Increased DTRs
- +Chvostek's and Trousseau's sign
- Irritability, psychosis, depression
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What does hypocalcemia show on an EKG?
A prolonged QT interval
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How do you tx acute hypocalcemia?
Calcium gluconate 1-2g IV over 20 min
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How do you tx chronic hypocalcemia?
Oral CaCO2 and Vit D if indicated
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How do you tx hypocalcemia in a renal failure pt?
Phosphate binders, calcitriol
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What is hypercalcemia?
>10.5(?)
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What are causes of hypercalcemia?
- Hyperparathyroidism
- Malignancy (SCC, breast, renal, bladder, myeloma)
- Vit D intoxication
- Increased bone turnover (Paget's)
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What are sx of hypercalcemia?
- "bones, stones, abdominal groans, psychic moans"
- Altered mental status, dehydration
- Fractures, osteopenia, nephrolithiasis
- Abd pain, anorexia, N/V, fatigue, weakness
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What labs do you order with hypercalcemia?
- Calcium
- albumin
- Ica
- PTH
- PO4
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What do EKG changes show with hypercalcemia?
short QT interval
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How do you tx acute hypercalcemia?
Saline + loop diuretics
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How do you tx hypercalcemia caused by malignancies?
Bisphosphonates, refer to onc
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