Calcium Disorders

what is the normal serum calcium level

8-10.4

What protein does calcium bind to?

albumin

what is the formula for correcting calcium

= calcium + 0.8(4-albumin)

what are the causes of hypocalcemia

hypoparathyroidism

secondary hyperparathyroidism

drugs

hypomagnesmia

what are the drugs that cause hypocalcemia

bisphosphonate

loop diuretics

Cinacalcet

what are the signs and symptoms of a patient with hypocalcemia

tetany

QT prolongation

muscle spasms

hallucinations

hair loss

seizures

hypotension

when do we use IV calcium in hypocalemia

symptomatic

corrected calcium less than or equal to 7.5

what is the dosing for IV calcium

1g CaCl or 2-3g calcium gluconate

what is the max dosing for IV Calcium per min and why

do not give >60mg/min- risk of cardiac arrythmias

what is the max dose for calcium per day and per dose

1-3g/day

500-600mg/dose

if we go above the max calcium/dose what could happen

cant be absorbed leading to constipation

what is hypercalcemia

>10.5

what are the causes of hypercalcemia

cancer

primary hyperparathyroidism

meds

what drugs causes hypercalcemia

lithium

thiazide diuretics

what are the s/sx of hypercalcemia

confusion

lethargy

anorexia

nausea

constipation

polydipsia/polyuria

short QT/ arrythmias

what is the treatment if a patient has severe or acute s/sx of hypercalcemia

NS 3-6L over 24 with or without loops

Calcitonin IV

Bisphosphonates

if a patient has renal impairment and severe hypercalcemia what should be used

denosumab

is what situation should loops be added to the treatment of a patient with hypercalcemia

volume overload (edema, JVD)

what is the caution when using IV NS

fluid sensitive patients- CKD, HF

what is the DOA of Calcitonin IV and what happens after

48 hrs

tachyphylaxis

what is the onset of action and DOA of bisphosphonates

1-3 days

2-4 weeks

what should be monitored when using bisphosphonates for treating severe hypercalcemia

flu like symptoms

what is denosumab used for

hypercalcemia of malignancy

when the patient is refectory to zoledronic acid or CI in bisphosphonates

what is the CrCl of a patient with renal impairment

<30

when should severe hypercalcemia be monitored

4-8 hrs