TAILIEUCHUNG - Chapter 047. Hypercalcemia and Hypocalcemia (Part 5)

Vitamin D deficiency, impaired 1,25(OH)2D production (primarily secondary to renal insufficiency), or, rarely, vitamin D resistance also cause hypocalcemia. However, the degree of hypocalcemia in these disorders is generally not as severe as that seen with hypoparathyroidism because the parathyroids are capable of mounting a compensatory increase in PTH secretion. Hypocalcemia may also occur in conditions associated with severe tissue injury such as burns, rhabdomyolysis, tumor lysis, or pancreatitis. The cause of hypocalcemia in these settings may include a combination of low albumin, hyperphosphatemia, tissue deposition of calcium, and impaired PTH secretion. . | Chapter 047. Hypercalcemia and Hypocalcemia Part 5 Vitamin D deficiency impaired 1 25 OH 2D production primarily secondary to renal insufficiency or rarely vitamin D resistance also cause hypocalcemia. However the degree of hypocalcemia in these disorders is generally not as severe as that seen with hypoparathyroidism because the parathyroids are capable of mounting a compensatory increase in PTH secretion. Hypocalcemia may also occur in conditions associated with severe tissue injury such as burns rhabdomyolysis tumor lysis or pancreatitis. The cause of hypocalcemia in these settings may include a combination of low albumin hyperphosphatemia tissue deposition of calcium and impaired PTH secretion. Clinical Manifestations Patients with hypocalcemia may be asymptomatic if the decreases in serum calcium are relatively mild and chronic or they may present with life-threatening complications. Moderate to severe hypocalcemia is associated with paresthesias usually of the fingers toes and circumoral regions and is caused by increased neuromuscular irritability. On physical examination a Chvostek s sign twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior to the ear may be elicited although it is also present in 10 of normal individuals. Carpal spasm may be induced by inflation of a blood pressure cuff to 20 mmHg above the patient s systolic blood pressure for 3 min Trousseau s sign . Severe hypocalcemia can induce seizures carpopedal spasm bronchospasm laryngospasm and prolongation of the QT interval. Diagnostic Approach In addition to measuring serum calcium it is useful to determine albumin phosphorus and magnesium levels. As for the evaluation of hypercalcemia determining the PTH level is central to the evaluation of hypocalcemia. A suppressed or inappropriately low PTH level in the setting of hypocalcemia establishes absent or reduced PTH secretion hypoparathyroidism as the cause of the hypocalcemia. Further history will

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