- 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.
