Hypocalcemia causes

PTH). Hypocalcemia caused by insufficient dietary calcium thus results in elevated levels of plasma 1,25 diOH D3. 1-Hydroxylase activity is also decreased by excess 1,25 diOH D3, the product of the reaction. 

Mishra R, Kaufman D, Mattern J 3 , Dutta SK. Severe hyperphosphatemia and hypocalcemia caused by bowel preparation for colonoscopy using oral sodium phosphate in end-stage renal disease. Endoscopy 2005 37 1259-60. 

The major effects of hyperphosphatemia are related to the development of hypocalcemia (caused by phosphate inhibition of renal la-hydroxylase) and its related consequences, as well as vascular and organ damage resulting from the deposition of calcium-phosphate crystals. Extravascular calcification can result in band keratopathy, red eye, pruritus, and periarticular calcification, especially in renal failure patients (see Chap. 44). In addition, soft-tissue calcifications in the conjunctiva, skin, heart, cornea, lung, gastric mucosa, and kidney have been observed, primarily in chronic renal failure patients." Hyperphosphatemia associated with chronic renal disease may result in renal osteodystrophy because of overproduction of parathyroid hormone. This condition is discussed in detail in Chap. 44. 

Hu J, Mora S, Colussi G, et al. Autosomal dominant hypocalcemia caused by a novel mutation in the loop 2 region of the human calcium receptor extracellular domain. J Bone Miner Res 2002 17 1461-1469. 

Mild exposure to HF via inhalation can irritate the nose, throat, and respiratory system. The onset of symptoms may be delayed for several hours. Severe exposure via inhalation can cause nose and throat bums, lung inflammation, and pulmonary edema, and can also result in other systemic effects including hypocalcemia (depletion of body calcium levels), which if not promptly treated can be fatal. Permissible air concentrations are (42) OSHA PEL, 3 ppm (2.0 mg/m ) as E OSHA STEL, 6 ppm (5.2 mg/m ) as E and ACGIH TLV, 3 ppm (2.6 mg/m ) as E. Ingestion can cause severe mouth, throat, and stomach bums, and maybe fatal. Hypocalcemia is possible even if exposure consists of small amounts or dilute solutions of HE. 

Both Hquid HE and the vapor can cause severe skin bums which may not be immediately painful or visible. HE can penetrate skin and attack underlying tissues, and large (over 160 cm ) bums may cause hypocalcemia and other systemic effects which may be fatal. Even very dilute solutions may cause bums. Both Hquid and vapor can cause irritation to the eyes, corneal bums, and conjunctivitis. 

Subsequent dosing based on clinical response ° May cause hypocalcemia, which may worsen the signs and symptoms of hypomagnesemia ° Hemodialysis ° Supportive care... 

Causes of hypocalcemia include hypoparathyroidism, hypomagnesemia, alcoholism, hyperphosphatemia, blood product infusion (due to chelation by the citrate buffers), chronic renal failure, vitamin D deficiency, acute pancreatitis, alkalosis, and hypoalbuminemia. Medications that cause hypocalcemia include phosphate replacement products, loop diuretics, phenytoin (Dilantin, available as generic), pheno-barbital (available as generic), corticosteroids, aminoglycoside antibiotics, and acetazolamide (available as generic).34,39,42... 

Hyponatremia, hypernatremia, hyperkalemia, hypocalcemia, hypomagnesemia, and hypoglycemia can cause SE... 

Electrolyte disturbances that develop in patients with tumor lysis syndrome should be managed aggressively to avoid renal failure from hyperphosphatemia and hypocalcemia and cardiac signs from hyperkalemia. One exception pertains to the use of intravenous calcium for hypocalcemia. Adding calcium may cause further calcium phosphate precipitation in the presence of hyperphosphatemia and should be used cautiously. 

Secondary hyperparathyroidism Increased secretion of parathyroid hormone from the parathyroid glands caused by hyperphosphatemia, hypocalcemia, and vitamin D deficiency that result from decreased kidney function. It can lead to bone disease (renal osteodystrophy). 

I 12. The answer is b. (Hardman, pp 1264-1265J Dactinomycin s major toxicities include stomatitis, alopecia, and bone marrow depression. Bleomycin s toxicities include edema of the hands, alopecia, and stomatitis. Mitomycin causes marked bone marrow depression, renal toxicity, and interstitial pneumonitis. Plicamycin causes thrombocytopenia, leukopenia, liver toxicity, and hypocalcemia. The latter may be of use in the treatment of hypercalcemia. Doxorubicin causes cardiotoxicity, as well as alopecia and bone marrow depression. The cardiotoxicity has been linked to a lipid peroxidation within cardiac cells. 

Hypocalcemia has been associated with causing anxiety, mood irritability, mania, psychosis, and delirium. 

Hypocalcemia results from altered effects of parathyroid hormone and vitamin D on the bone, gut, and kidney. The primary causes are postoperative hypoparathyroidism and vitamin D deficiency. 

After acute hypocalcemia is corrected, the underlying cause and other electrolyte problems should be corrected. 

Pidasheva, S., D Souza-Li, L., Canaff, L., Cole, D. E. C., and Hendy, G. N. (2004) CASRdb calcium-sensing receptor locus-specific database for mutations causing familial (benign) hypocalciuric hypercalcemia, neonatal severe hyperparathyroidism, and autosomal dominant hypocalcemia. Hum. Mutat. 24, 107-111. 

There is little reported information on industrial exposure, although chronic inflammation of the upper respiratory tract has been described in a worker exposed to hot vapor arising from oxalic acid. Ingestion of as little as 5 g has caused fatalities there is rapid onset of shock, collapse, and convulsions. The convulsions are thought to be the result of hypocalcemia due to the calcium-complexing action of oxalic acid, which depresses the level of ionized calcium in body fluids. Marked renal damage from deposition of calcium oxalate may occur. A study of railroad car cleaners with heavy exposure to oxalic acid solutions found an increased incidence of urinary stones. There was a 53% incidence of urolithiasis in exposed workers compared with a rate of 12% in unexposed workers from the same company. ... 

Oral As a dietary supplement when calcium intake may be inadequate. Conditions that may be associated with calcium deficiency include the following Vitamin D deficiency, sprue, pregnancy and lactation, achlorhydria, chronic diarrhea, hypoparathyroidism, steatorrhea, menopause, renal failure, pancreatitis, hyperphosphatemia, and alkalosis. Some diuretics and anticonvulsants may precipitate hypocalcemia, which may validate calcium replacement therapy. Calcium salt therapy should not preclude the use of other corrective measures intended to treat the underlying cause of calcium depletion. 

Hypercalcemia from any cause predisposes the patient to digitalis toxicity. Calcium, particularly when administered rapidly by the IV route, may produce serious arrhythmias in digitalized patients. On the other hand, hypocalcemia can nullify the effects of digoxin in humans thus, digoxin may be ineffective until serum calcium is restored to normal. 

Severe - Leukopenia (less than 1000/mm ) 2.8% hypoglycemia (less than 25 mg/dL) 2.4% thrombocytopenia (less than 20,000/mm ) 1.7% hypotension (less than 60 mm Hg systolic) 0.9% acute renal failure (serum creatinine greater than 6 mg/dL) 0.5% hypocalcemia (0.2%) Stevens-Johnson syndrome and ventricular tachycardia (0.2%) fatalities caused by severe hypotension, hypoglycemia, and cardiac arrhythmias. 

Uses Rx prevent osteoporosis male female, Rx steroid-induced osteoporosis, Paget Dz Action -1- N1 abnormal bone resorption Dose Osteoporosis Rx 10 mg/d PO or 70 mg qwk Fosamax plus D 1 tab qwk Steroid-induced osteoporosis Rx 5 mg/d PO Prevention 5 mg/d PO or 35 mg qwk Paget Dz 40 mg/d PO Caution [C, ] Not OK if CrCl <35 mLAnin, w/ NSAID use Contra Esophageal anomalies, inability to sit/stand upright for 30 min, X Ca Disp Tabs, soln SE GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Interactions -1- Absorption W7 antacids, Ca supls, Fe, food T risk of upper GI bleed W/ ASA NSAIDs EMS May cause cardiac conduction abnormalities d/t T Ca T risk of jaw fractures esp w/ dental procedures OD May cause hypocalcemia and adverse upper-GI effects milk or antacids can be given to bind alendronate... 

WARNING Renal impair is the major tox foUow administration instructions Uses CMV retinitis w/ HIV Action Selective inhibition of viral DNA synth Dose Rx 5 mg/kg IV over 1 h once/wk for 2 wk w/ probenecid Maint 5 mg/kg IV once/2 wk w/ probenecid (2 g PO 3 h prior to cidofovir, then 1 g PO at 2 h 8 h after cidofovir) X in renal impair Caution [C, -] Contra Probenecid or sulfa allergy Disp Inj SE Renal tox, chills, fever, HA, NA /D, thrombocytopenia, neutropenia Interactions t Nephrotox W/ aminoglycosides, amphot icin B, foscar-net, IV pentamidine, NSAIDs, vancomycin t effects W/zidovudine EMS Monitor ECG for hypocalcemia (t QT int val) and hypokalemia (flattened T waves) OD May cause renal failure hydration may be effective in reducing drug levels/effects Cilostazol (Pletal) TAntiplatelet, Arterial Vasodilator/ Phosphodiesterase Inhibitor] Uses Reduce Sxs of intermittent claudication Action Phosphodiesterase in inhibitor t s cAMP in pits blood vessels, vasodilation inhibit pit aggregation Dose 100 mg PO bid, 1/2 h before or 2 h after breakfast dinner Caution [C, +/-] Contra CHE, hemostatic disorders. 

Adults. 3 g PO q6h x 4 PRN Supl 1-2 g IM or IV repeat PRN Preeclampsia/pre-mature labor 4 g load then g/h IV inf Cardiac arrest 1-2 g IV push (2-4 mL 50% soln) in 10 mL DjW AMI Load 1-2 g in 50-100 mL D5W, over 5-60 min IV then 0.5-1.0 g/h IV up to 24 h (ECC 2005) Feds. 25-50 mg/kg/dose IM or IV q4-6h for 3-4 doses repeat PRN dose w/ low urine output or renal insuff Caution [B, +] Contra Heart block, renal failure Disp Inj 10, 20, 40, 80, 125, 500 mg/mL bulk powder SE CNS depression, D, flushing, heart block Interactions T CNS depression W/ antidepressants, antipsychotics, anxiolytics, barbiturates, hypnotics, narcotics EtOH T neuromuscular blockade Wf aminoglycosides, atracurium, gallamine, pancuronium, tubocurarine, vecuronium EMS Check for absent patellar reflexes this may indicate tox may cause hypokalemia (flattened T waves) and hypocalcemia OD May cause hypotension, resp arrest, T PR, QRS, and QT interval, AV block, and cardiac arrest calcium salts can be given to reverse resp depression... 

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