Calcium homeostasis and pathologies

• What are the physiological functions of calcium ?

• Is calcium considered a clotting factor ? If yes which one ?

• What is the normal range of calcium in the body ?

• In which form is it circulating in the blood ? What part of the circulating calcium is responsible for it’s physiological role ?

• How do acid –base disorders affect calcium homeostasis ?

• How is the calcium level maintained at it’s normal physiological range ?

Hypercalcemia

• What are the clinical manifestations of hypercalcemia ?

• What are the possible causes of hypercalcemia and how are they classified ?

• What are the steps to diagnose the cause of hypercalcemia ?

• What is the most common cause of hypocalcemia in outpatient vs. hospital settings ?

• Name medications known to cause hypercalcemia ?

• How does lithium cause hypercalcemia ?

• What are the possible mechanisms behind hypercalcemia of malignancy ?

What are the common malignancies as culprits of each type ?

Causes of hypercalcemia , classification

Treatment

• What are the steps in management of a patient with acute hypercalcemic crisis ?

• What are the indications for parathyroidectomy in hyperparathyroidism ? ( chronic management )

• How is the treatment of hypercalcemia caused by granulomatous disease different from other mechanisms ?

Hypocalcemia

• What are the acute manifestations of hypocalcemia ? How is it managed acutely ?

• What is hyperventilation syndrome and how does it lead to the same clinical presentation as hypocalcemia , despite normal serum total calcium level ? how is it managed ?

Management of acute hypocalcemia

• In patients with marked hypocalcemia , calcium should be delivered by slow continuous intravenous infusion ( for example , calcium gluconate as 0.5-1.5 mg elemental calcium /kg body weight / hour till symptoms subside , With continuous cardiac monitoring , especially QT interval .

Approach to chronic hypocalcemia

• What is the most common acquired cause of hypoparathyroidism ?

• Mention other possible causes of hypoparathyroidism ?

• Mention a congenital cause ?

• How does hemochromatosis cause hypocalcemia ?

• Mention 5 causes of hypocalcemia with normal or high PTH levels with the mechanism behind each of them ?

Management of chronic hypocalcemia

• Why is the target calcium kept at the lower limit of normal not to be exceeded in patients with hypoparathyroidism ?

Thank you