Parathyroid hormone - Increases renal absorption of calcium
Increases excretion of phosphate
Increases bone resorption
increases intestinal calcium absorption
Increases Vit D synthesis
Calcium is bound to what in plasma? - Albumin
Vitamin D metabolism - skin photoconversion or reabsorbed in gut -> 1st hydroxylation in liver -> 2nd
hydroxylation in kidney's proximal tubule (alpha-1-hydroxylase)
Causes of hypercalcaemia - Hyperparathyroidism
Excess Vitamin D
Thiazide diuretics
Excess calcium intake
Malignant disease
Sarcoidosis
Clinical features of hypercalcaemia - Polydipsia, polyuria
Abdominal pain
Renal calculi
Peptic ulcer
High serum calcium and low phosphate - Excess PTH
Excess of serum calcium and phosphate - Excess Vitamin D
, Management of Hypercalcemia - Rehydration
Loop diuretic
Monitor potassium
Bisphosphonates
Hypocalcaemia: Causes - Renal failure
Hypoparathyroidism
Vitamin D deficiency
Hypomagnesaemia (PTH less effective if magnesium is low)
Bisphosphonates
Clinical features of hypocalcaemia - Tetany
+ve Chovstek's & Trousseau's sign
Prolonged QT interval
Management of severe hypocalcaemia - IV calcium gluconate
Phosphate - Mainly intracellular
Required for ATP
85% in bone
Causes of hypophosphatemia - Poor diet, malabsorption
Shift into cells (Respiratory alkalosis, Insulin etc)
Increase urine excretion (hyperparathyroidism)
Renal tubular defects
Clinical features of hypophosphataemia - Seen in refeeding syndrome
May be associated with alcoholism
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