• MKSAP Question: Illness script for Asian female with metastatic lung adenocarcinoma – check for the EGFR mutation
  • Approach to Hypocalcemia: Check the PTH level. Causes of hypocalcemia with high PTH include Vit D resistance, pancreatitis, CKD. Causes of hypocalcemia with low PTH include destruction of the parathyroid gland (autoimmune, surgery).
  • Clinical Manifestations of Hypocalcemia: Peri-oral numbness, paresthesias, tetany, seizures, papilledema, etc
    • Tetany = neuromuscular irritability
    • Chvostek’s Sign
    • Trousseau’s Sign
  • Indications for IV Calcium drip
    • Rapid drop of total calcium to < 7.5
    • Symptomatic hypocalcemia (tetany, carpopedal spasm, seizures)
    • Prolonged QTC
  • The two main causes for hypocalcemia in ESRD are hyperphosphatemia (inability to excrete phosphorous) and lack of calcitriol production by the kidney.
  • Treatments for secondary hyperparathryoidism in ESRD include phosphorous binders, calcitriol, and calcimimetics.

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