General Physical
Keith Hopcroft, Vincent Forte in Symptom Sorter, 2020
SMALL PRINT: serum and urine osmolality, sickle-cell screen. Urinalysis: glycosuria in diabetes, specific gravity raised in dehydration and reduced in diabetes insipidus and compulsive water drinking, may be proteinuria and/or microscopic haematuria in CKD.Fasting blood glucose or HbA1c: to definitively diagnose diabetes.FBC/ESR: Hb may be reduced and ESR elevated in Sjögren’s linked to connective tissue disorder; Hb may also be reduced in CKD.U&E: may suggest dehydration or CKD.Calcium: elevated in hypercalcaemia.Rheumatoid factor and other autoantibodies: Sjögren’s may be linked to rheumatoid arthritis, SLE or other connective tissue disease.Serum and urine osmolality: serum osmolality raised and urine osmolality low in diabetes insipidus; in compulsive water drinking, serum osmolality low.Sickle-cell screen: to detect sickle-cell anaemia.
The minerals
Geoffrey P. Webb in Nutrition, 2019
Any variation in the calcium concentration of body fluids can thus have diverse effects on many systems of the body and the calcium concentration in extracellular fluids is under very fine hormonal control. The skeletal calcium not only strengthens bones, but also serves as a reservoir of calcium. The skeleton can donate or soak up excess calcium and thus enable the concentration in extracellular fluid to be regulated within narrow limits. A fall in blood calcium concentration, as seen after removal of the parathyroid glands or in extreme vitamin D deficiency, leads to muscle weakness and eventually to tetany and death due to asphyxiation when the muscles of the larynx go into spasm. A rise in plasma calcium is seen in vitamin D poisoning and in hyperparathyroidism. This hypercalcaemia can lead to gastrointestinal symptoms, neurological symptoms, formation of kidney stones and in some cases may lead to death from renal failure.
Endocrine disorders
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Primary hyperparathyroidism in childhood most commonly results from a solitary hyperfunctioning adenoma, and more rarely from diffuse hyperplasia of all four glands. Patients typically have only small elevations in serum calcium concentrations (less than 11 mg/dL or 2.75 mmol/L), and many have mostly high-normal values with intermittent hypercalcaemia. Hyperparathyroidism resulting from hyperplasia in all four glands is a feature of MEN1. Furthermore, approximately 30% of patients with MEN2A develop hyperparathyroidism. Primary hyperparathyroidism of infancy is a rare disorder that is often fatal. In about one-half of reported cases there is a familial component to the disease. The condition usually develops within the first 3 months of life, and presenting signs include hypotonicity, respiratory distress, failure to thrive, lethargy and polyuria. Pathologically, there is usually diffuse parathyroid gland hyperplasia. Early recognition and treatment of primary hyperparathyroidism of infancy is essential for normal growth and development of the baby. Once the diagnosis of hyperparathyroidism is established, the offending parathyroid tissue should be resected. There is no place for medical management of primary hyperparathyroidism in children
Regional citrate anticoagulation versus low molecular weight heparin anticoagulation for continuous venovenous hemofiltration in patients with severe hypercalcemia: a retrospective cohort study
Published in Renal Failure, 2020
Yan Yu, Ming Bai, Zhang Wei, Lijuan Zhao, Yangping Li, Feng Ma, Shiren Sun
The baseline characteristics of the included patients are described in Table 1. Overall, 75.8% of the patients were male with a mean age of 56.3 ± 17.2 years. Patients in the LMWH-anticoagulation group were older than those in the RCA group (60.0 ± 14.8 vs. 46.4 ± 20.2, p = .042). The median serum calcium was 3.78 ± 0.52 mmol/L before CVVH. The two groups did not have significantly different serum calcium levels or remaining baseline characteristics (Table 1). The causes of hypercalcemia were malignancy (including multiple myeloma, non-Hodgkin lymphoma, hepatoma, esophageal cancer and acute leukemia) in 78.7% of the patients and primary parathyroid adenoma in 21.2% of the patients. AKI (27/33, 81.8%), somnolence (6/33, 18.2%), and arrhythmia (3/33, 9.1%) were the most common serious symptoms of hypercalcemia, followed by coma (2/33, 6.1%).
Biosimilarity of HS-20090 to Denosumab in healthy Chinese subjects: a randomized, double-blinded, pharmacokinetics/pharmacodynamics study
Published in Expert Opinion on Investigational Drugs, 2022
Yaqi Lin, Heng Yang, Xiaoyan Yang, Can Guo, Shuang Yang, Guoping Yang, Qiong Wu, Chao Pan, Changan Sun, Chuan Li, Liangliang He, Jie Huang, Qi Pei
Denosumab binds to RANKL, thereby modulating calcium release from bone. Normal serum calcium levels are 8–10 mg/dL (2.0–2.5 mmol/L), although the exact range can vary among laboratories [13]. In this study, normal serum calcium levels are 2.2–2.7 mmol/L. When the total serum calcium level is at concentrations of 2.1 mmol/L or less, it was considered hypocalcemia. Hypercalcemia is judged by our research doctor if the total serum calcium level is higher than 2.8 mmol/L. Both of them are graded according to the CTCAE. Reduced release of calcium from the bone eventually leads to hypocalcemia. However, several subjects had the hypercalcemia during the study, which might be the rebound-linked phenomenon after Denosumab discontinuation [14]. In addition, Denosumab could also affect the parathyroid gland function. Increased blood parathyroid hormone was observed in this study, which might be a compensatory response to the transient dose-dependent decrease in serum calcium levels [15]. The increased PTH levels might lead to an increased phosphorus excretion in the absence of osteoclastic liberation of bone phosphorus, consequently resulting in a hypophosphatemia [16].
Symptomatic hypercalcemia and scarring alopecia as presenting features of sarcoidosis
Published in Baylor University Medical Center Proceedings, 2018
Jillian Frieder, Dario Kivelevitch, Alan Menter
Sarcoidosis is a multisystemic granulomatous disease with a peak onset between the ages of 20 and 40 years. It is slightly more common in women, and the incidence is especially high in African Americans (40 to 70 per 100,000 population per year) compared to Caucasians (5 to 19 per 100,000).1 Though cutaneous involvement is a common extrathoracic manifestation (20%–35%), sarcoidosis of the scalp is a rare clinical entity.2 Aberrant calcium metabolism is also associated with sarcoidosis and other granulomatous diseases, presenting most commonly with hypercalciuria. Symptomatic hypercalcemia is seen in a small proportion of cases (approximately 5%) and rarely causes kidney damage.3,4 We report an unusual case of sarcoidosis presenting with symptomatic hypercalcemia, scarring alopecia, and acute-on-chronic kidney failure.
Related Knowledge Centers
- Abdominal Pain
- Arrhythmia
- Calcium
- Cardiac Arrest
- Confusion
- Depression
- Serum
- Weakness
- Kidney Stone Disease
- Primary Hyperparathyroidism