Endocrinology Question 34 Instructor

List 6 diagnoses on the differential for hypocalcemia.

Hypocalcemia with low PTH (hypoparathyroidism):

  • Surgical/Autoimmune destruction of the parathyroid glands
  • Abnormal parathyroid gland development
  • Altered regulation of PTH

Hypocalcemia with high PTH:

  • PTH resistance (impaired PTH action)
  • Vitamin D deficiency/resistance
  • Extravascular deposition
    • Hyperphosphatemia
    • Osteoblastic metastases
    • Acute pancreatitis
  • Sepsis or severe illness

Disorders of magnesium metabolism:

  • Drugs:
    • Calcium chelators
    • Bisphosphonates
    • Cinacalcet
    • Chemotherapy
    • Foscarnet
    • Fluoride poisoning

What are two clinical findings in the patient with hypocalcemia?

  • Trousseau’s sign
  • Chvostek’s sign: twitching facial muscles when the facial nerve is tapped on

How do you treat severe hypocalcemia (corrected calcium <1.85, or calcium between 1.85-2 mmol/L with symptoms/signs)?

  1. 1 vial calcium gluconate (1 g of calcium/10 mL vial) in 50 mL of D5W over 5 minutes iv
  2. then give 1 mg/kg/ml iv for 5-10 hours, checking serum calcium levels in 6 hours
  3. eventually switch to oral calcium carbonate 1250 mg bid (=500 mg of elemental calcium) tid +/- rocaltriol 0.25 mcg od-bid

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