Hypocalcemia

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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