0071643192.pdf

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS

Symptoms of

hypercalcemia—

Stones, bones,

abdominal groans,

psychiatric

overtones

Stones (renal)

Bones (fractures/mets)

Abdominal groans

(vomiting,

constipation)

Psychiatric overtones

(weakness, AMS)

CAUSES

Causes are grouped into four categories:

■ Malignancy:Most common in hospitalized patients

■ Primary hematologic or metastatic to bone

■ Parathyroid producing tumor

■ Hyperparathyroidism: Most common in nonhospitalized patients

■ Increased intake

■ Milk-alkali syndrome

■ Vitamin D or A toxicity

■ Increased bone breakdown

■ Immobilization

■ Paget disease

SYMPTOMS

■ Lethargy and weakness

■ Constipation

■ Anorexia

EXAM

■ Neuromuscular

■ Confusion→lethargy→stupor→coma with increasing Ca^2 +

■ Weakness, hypotonia, and hyporeflexia

■ Apathy or depression

■ Cardiovascular effects

■ Hypertension

■ Arrhythmias

■ Digitalis sensitization

■ Shortened QT interval

■ ST and T-wave coving or T-wave widening

■ Renal

■ Renal failure

■ Nephrolithiasis

■ Polyuria

TREATMENT

■ Hydration

■ Furosemide increases calcium excretion, especially useful in patients with

fluid overload

■ Hydrocortisone

■ Drugs that decrease bone absorption: Calcitonin, bisphosphonates, and

mithramycin

■ Potassium replacement

■ Treatment of underlying cause

MAGNESIUM

■ Approximately 60% of the 24 g of magnesium are contained in bone with

the remaining 40% intracellular. Because of this, magnesium regulation is

related to calcium and phosphate.

■ Intake is generally through leafy green vegetables.

■ It plays crucial roles in the clotting cascade and neuromuscular activity.