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Clinical Skills Blogspot

Calcium Studies

Analyse

Ñ  Calcium

Ñ  Phosphate

Ñ  Alkaline phosphatase

Ñ  Parathyroid hormone (PTH)

 

Calcium

Calcium circulates in the blood stream as:

Ñ  Calcium bound to plasma proteins

Mainly albumin

Ñ  Ionised calcium

·         Ionised calcium increases in acidosis

Less bound to albumin

·         Ionised calcium decreases in alkalosis

More bound to albumin

Ñ  Complexed with organic anions

 

Hypercalcaemia

Title:                            

Ñ  Hypercalcaemia

Definition:

Ñ  Increase in calcium corrected for changes in albumin

Pathogenesis

Pathological Process

Ñ  Calcium homeostasis is influenced by absorption, distribution and excretion by the gastrointestinal tract, bones and kidneys

This is under the influence of:

Ñ  Vitamin D

Ñ  PTH

Ñ  Calcitonin

Ñ  Acid base balance

Ñ  Other Hormones

·         Growth hormone, somatomedins

·         Thyroid hormones

·         Insulin

·         Oestrogens

·         Corticosteroids

Ñ  Growth factors

·         Epidermal

·         Fibroblast

·         Platelet derived

Ñ  Prostaglandins

·         Prostaglandin E₂

Causes

 

E&M:

·         Hyperparathyroidism

·         Primary

·         Tertiary

Ñ  Thyrotoxicosis

Ñ  Acromegaly

Ñ  Adrenal insufficiency

RS:

Ñ  Sarcoidosis

Ñ  Tuberculosis

HS:

Ñ  Myeloma

Ñ  Lymphoma

LMS:

Ñ  Bone metastases

Ñ  Paget’s disease

Drugs

Ñ  Hypervitaminosis D

Ñ  Thiazides

Ñ  Lithium

 

Hypocalcaemia

Title:                            

Ñ  Hypocalcaemia

Definition:

Ñ  Decreased corrected calcium

Pathogenesis

Pathological Process

Ñ  Control of calcium homeostasis as above

Causes

 

E&M:

Ñ  Hypoparathyroidism

Ñ  Pseudohypoparathyroidism

Ñ  Hypomagnesaemia

Ñ  Vitamins D deficiency

RS:

Ñ  Respiratory alkalosis

GIT:

Ñ  Acute pancreatitis

Ñ  Liver disease

KUS:

Ñ  Chronic renal failure

Ñ  Renal tubular acidosis

HS:

Ñ  Massive blood transfusion with citrated blood

Drugs:

Ñ  Diuretics

Ñ  Calcitonin

Ñ  Bisphosphonates

Ñ  Cytotoxics

Ñ  Calcium chelators

 

Phosphate

Ñ  Metabolism usually inversely related to calcium

Ñ  Urinary output affected by

·         Acid base balance

·         Renal function

 

Hyperphosphataemia

Title:                            

Ñ  Hyperphosphataemia

Definition:

Ñ  Increased phosphate levels in blood

Pathogenesis

Pathological Process

Causes

 

E&M:

Ñ  Hypoparathyroidism

Ñ  Pseudohypoparathyroidism

Ñ  Hypervitaminosis D

Ñ  Catabolic states

Ñ  Metabolic acidosis

KUS:

Ñ  Renal failure

HS:

Ñ  Haemolysis

 

Hypophosphataemia

Title:                            

Ñ  Hypophosphataemia

Definition:

Ñ  Decreased phosphate levels in blood

Pathogenesis

Pathological Process

Causes

 

E&M:

Ñ  Hyperparathyroidism

Ñ  Vitamin D deficiency

Ñ  Recovery from diabetic ketoacidosis

GIT:

Ñ  Nutritional failure

Ñ  Refeeding syndrome

Ñ  Antacid therapy

KUS:

Ñ  Renal tubular disease

Toxins:

Ñ  Alcoholism

 

Alkaline Phosphatase

Alkaline phosphatase may arise from

LMS

Heat stable

Ñ  Bone

GIT

Heat labile

Ñ  Liver

Ñ  Intestine

Ñ  Pancreas

RAG

Heat labile

Ñ  Placenta

 

Increased Alkaline phosphatase

Title:                            

Ñ  Increased Alkaline phosphatase

Definition:

Ñ  Increase in blood levels of alkaline phosphatase

Pathogenesis

Pathological Process

Causes

 

E&M:

Ñ  Hyperparathyroidism

GIT:

Ñ  Obstructive jaundice

Ñ  Cirrhosis of the liver

Ñ  Space occupying lesions

LMS:

Ñ  Bone metastases

Ñ  Paget’s disease

Ñ  Osteomalacia / rickets

 

Decreased alkaline phosphatase

Title:                            

Ñ  Decreased alkaline phosphatase

Definition:

Ñ  Decreased levels of alkaline phosphatase in the blood

Pathogenesis

Pathological Process

Causes

 

E&M:

Ñ  Cretinism

LMS:

Ñ  Hypophosphatasia

GIT

Ñ  Wilson’s disease

 

Normal Alkaline Phosphatase

Title:                            

Ñ  Normal Alkaline Phosphatase

Definition:

Ñ  Normal alkaline phosphatase in the context of calcium studies

Pathogenesis

Pathological Process

Causes

 

E&M:

Ñ  Hypoparathyroidism

Ñ  Vitamin D intoxication

RS:

Ñ  Sarcoidosis

HS:

Ñ  Myeloma

LMS:

Ñ  Osteoporosis

 

High PTH

Title:                            

Ñ  High PTH

Definition:

Ñ  Increased levels of PTH in blood

Pathogenesis

Pathological Process

Causes

E&M:

Ñ  Hyperparathyroidism

Ñ  Pseudohypoparathyroidism

KUS:

Ñ  Renal failure

LMS:

Ñ  Osteomalacia / rickets

Ñ  Paget’s disease of bone

Ñ  Bone metastases

 

Low PTH

Title:                            

Ñ  Low PTH

Definition:

Ñ  Decreased PTH levels in blood

Pathogenesis

Pathological Process

Causes

 

E&M:

Ñ  Hypoparathyroidism

 

 

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