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Pathology
Normal range for serum Ca2+ is 2.25-2.5mmol/l. A large amount of Ca2+ is transported bound to proteins so corrected calcium calculations are used.
Aetiology
aised PTH:
Primary hyperparathyroidism
Normal PTH:
Malignancy (paraneoplastic or due to bone metastases)
Genetic e.g. familial hypocalciuric hypercalcemia
Endocrine e.g. hyperthyroidism, hypoadrenalism, phaeochromocytoma
Drugs e.g. thiazides, vitamin D and A supplements
Sarcoidosis
TB
Others:
Immobility
AIDS
Milk-alkali syndrome
Signs
Mild: Mild cognitive impairment.
Moderate: Muscle weakness.
Severe: Dehydration, arrhythmias, coma.
Symptoms
Mild: Polyuria, polydipsia, dyspepsia.
Moderate: Constipation, anorexia, nausea, fatigue.
Severe: Abdominal pain, lethargy..Investigations
Bloods: Corrected Ca2+, PTH, U&Es, LFTs, Vitamin D, Phosphate, Magnesium,
Serum ACE (Sarcoidosis)
Urine: Calcium
Imaging: Renal ultrasound, ultrasound neck, SestaMIBI of parathyroids, bone
scan for metastases
Treatment
Poor in malignant causes, otherwise good with treatment.
Prognosis
Poor in malignant causes, otherwise good with treatment.
Arrhythmias, shortened QT interval on ECG, pancreatitis, renal stones if chronic, renal tubular acidosis.Key Facts
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Key Images
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Key References
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