GLYCOSURIA HYPERCALCEMIA

GlycosuriaGlycosuria

The presence of sugar or glucose in The presence of sugar or glucose in the urinethe urine– Two basic causes:Two basic causes:

Blood glucose levels are so elevated that the Blood glucose levels are so elevated that the renal tubules are unable to reabsorb all that renal tubules are unable to reabsorb all that is presentis present

Failure of tubules to reabsorb when glucose Failure of tubules to reabsorb when glucose levels are normallevels are normal

– Renal glycosuriaRenal glycosuria

Blood Glucose LevelsBlood Glucose Levels Under normal circumstances about 10 mmol/L Under normal circumstances about 10 mmol/L It can occur in the non-diabetic if a substantial It can occur in the non-diabetic if a substantial

amount of food high in sugar is consumed and amount of food high in sugar is consumed and transiently overwhelms the insulin response transiently overwhelms the insulin response causing hyperglycemia causing hyperglycemia

Some hyperglycemia causesSome hyperglycemia causes– ThyrotoxicosisThyrotoxicosis– AcromegalyAcromegaly– Severe anxietySevere anxiety– Diabetes mellitusDiabetes mellitus– Cushing’s diseaseCushing’s disease– Pancreas dysfunctionPancreas dysfunction

Glycosuria occurs when a normal renal threshold Glycosuria occurs when a normal renal threshold has been exceeded due to hyperglycemiahas been exceeded due to hyperglycemia

Renal GlycosuriaRenal Glycosuria

In pregnancyIn pregnancy– Results from increased renal blood flow Results from increased renal blood flow – Tubules are presented with a greater Tubules are presented with a greater

volume each minutevolume each minute– May be the first sign of gestational May be the first sign of gestational

diabetes diabetes

Renal GlycosuriaRenal Glycosuria

Other causesOther causes– Fanconi’s SyndromeFanconi’s Syndrome

Inadequate proximal renal tubular Inadequate proximal renal tubular reabsorption of glucosereabsorption of glucose

Inherited or acquiredInherited or acquired Other symptoms includeOther symptoms include

– growth failure, rickets, polyuria, polydipsia, or growth failure, rickets, polyuria, polydipsia, or dehydration dehydration

Renal GlysuriaRenal Glysuria Some secondary causes:Some secondary causes:

– Oculocerebrorenal dystrophy (Lowe's syndrome) Oculocerebrorenal dystrophy (Lowe's syndrome) – CystinosisCystinosis– Wilson's diseaseWilson's disease– Interstitial nephritisInterstitial nephritis– Hereditary tyrosinemia Hereditary tyrosinemia – Heavy metal poisoning such as lead, mercury or Heavy metal poisoning such as lead, mercury or

after use of out-of-date tetracycline after use of out-of-date tetracycline – Intestinal glucose-galactose malabsorption Intestinal glucose-galactose malabsorption

(where the defective sodium-dependent glucose (where the defective sodium-dependent glucose co-transporter protein is also present in the renal co-transporter protein is also present in the renal tubules)tubules)

Benign GlycosuriaBenign Glycosuria

Occurs without significant pathology Occurs without significant pathology Divided into 3 categoriesDivided into 3 categories

– Type A Type A Classical glycosuria, with reduction in both glucose Classical glycosuria, with reduction in both glucose

threshold and maximal glucose reabsorption ratethreshold and maximal glucose reabsorption rate

– In type B In type B Reduction in the glucose threshold and a normal rate Reduction in the glucose threshold and a normal rate

of reabsorption of reabsorption

– Type O Type O Failure of glucose reabsorptionFailure of glucose reabsorption Plasma glucose, glucose tolerance test (GTT), insulin Plasma glucose, glucose tolerance test (GTT), insulin

levels and HbA1C are all normallevels and HbA1C are all normal

HypercalcemiaHypercalcemia

Condition of excessive calcium levels in Condition of excessive calcium levels in the bloodthe blood– Normal range: 9-10.5 mg/dL or 2.2-2.6 mmol/L Normal range: 9-10.5 mg/dL or 2.2-2.6 mmol/L – Symptoms are more common at high calcium Symptoms are more common at high calcium

blood values blood values 12.0 mg/dL or 3 mmol/l). 12.0 mg/dL or 3 mmol/l).

– Severe hypercalcemia Severe hypercalcemia above 15-16 mg/dL or 3.75-4 mmol/l above 15-16 mg/dL or 3.75-4 mmol/l considered a medical emergencyconsidered a medical emergency

– coma and cardiac arrest can resultcoma and cardiac arrest can result

Signs and SymptomsSigns and Symptoms

Some signs of Some signs of hypercalcemiahypercalcemia– fatiguefatigue– depressiondepression– confusionconfusion– anorexia anorexia – nausea nausea – vomiting vomiting – constipation constipation – pancreatitis pancreatitis – polyuriapolyuria

Chronic Chronic hypercalcemiahypercalcemia– Urinary calculi Urinary calculi

(renal stones or (renal stones or bladder stones) bladder stones)

– Abnormal heart Abnormal heart rhythms ECG rhythms ECG findings of a short findings of a short QT interval and a QT interval and a widened T wave widened T wave

Peptic ulcers may Peptic ulcers may also occuralso occur

Remember: "Remember: "groansgroans (constipation), (constipation), moansmoans (psychotic noise), (psychotic noise), bonesbones (bone pain, especially if (bone pain, especially if

PTH is elevated), and PTH is elevated), and stonesstones (kidney stones)” (kidney stones)”

– Excessive skeletal Excessive skeletal calcium releasecalcium release

– Increased intestinal Increased intestinal calcium absorptioncalcium absorption

– Decreased renal Decreased renal calcium excretioncalcium excretion

– Indicative of Indicative of another disease another disease

– Hyperparathyroidism Hyperparathyroidism and malignancy and malignancy account for about account for about 90% of 90% of hypercalcemiahypercalcemia

– Other causesOther causes CancerCancer Disorders related to Disorders related to

bone lossbone loss MedicationsMedications Excessive use of Excessive use of

calcium and vitamin calcium and vitamin D supplements D supplements

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… for more information on hypercalcemia!

resources citedresources cited

aafp.orgaafp.org Fremgen, Bonnie F. & Frucht, Fremgen, Bonnie F. & Frucht,

Suzanne S. Suzanne S. Medical Terminology: A Medical Terminology: A Living Language: 3e.Living Language: 3e. New Jersey: New Jersey: Pearson Education. 2005Pearson Education. 2005

patient.co.ukpatient.co.uk wikipedia.orgwikipedia.org