CMC - OBJECTIF 12-2a : TROUBLES DU METABOLISME DU CALCIUM : HYPOCALCEMIE

CALCIUM METABOLISM DISORDERS: HYPOCALCEMIA EXPLANATION Patients with hypocalcemia are at risk for tetany and/or seizures, particularly if it begins acutely. Severe or prolonged hypercalcemia can cause irreversible target organ damage and be life-threatening. Etiology 1. Hypocalcemia a. Decreased plasma calcium levels 1. Hyperphosphatemia (e.g., renal failure) 2. Pancreatitis 3. Osteoblastic metastases 4. Drug-induced (e.g., ethylenediaminetetraacetic acid [EDTA]) 5. Rhabdomyolysis b. Decreased vitamin D synthesis or action 1. Renal failure 2. Rickets 3. Malabsorption 4. Neonatal decrease c. Decreased Parathyroid Hormone Synthesis or Action 1. Postoperative Decrease (e.g., postparathyroidectomy) 2. Autoimmune Decrease 3. Decreased Response d. Hypomagnesemia PRIMARY OBJECTIVES Given a patient with hypocalcemia or hypercalcemia, the candidate will diagnose the cause, severity, and complications, and develop an appropriate management plan. SPECIFIC OBJECTIVES Given a patient with hypocalcemia, the candidate will: 1. Identify and interpret critical clinical findings, including: a. Differentiate between hypocalcemia due to renal disease and hypocalcemia due to other causes; b. Signs and symptoms of tetany; 2. Identify and interpret critical clinical investigations, including: a. Measurement of ionized calcium and/or total calcium levels, corrected for albumin, to assess the severity of hypocalcemia; b. Measurement of phosphate, magnesium, parathyroid hormone, and vitamin D, as well as assessment of renal function; 3. Establish an effective initial management plan, including: a. Administer intravenous calcium for symptomatic hypocalcemia; b. Determine whether the patient requires specialized care. BIBLIOGRAPHICAL REFERENCES 1. Treatment of hypocalcemia – UpTo-Date, 2011 2. Disorders of the calcium-sensing receptor: familial hypocalciuric hypercalcemia and autosomal dominant hypocalcemia – UpToDate, 2021 3. Disorders related to calcium metabolism – Endocrine Biomarkers, 2017 4. Genetic Disorders of Calcium and Phosphorus Metabolism Related with Parathyroid Glands – Parathyroid Glands – New Aspects, 2022 5. Disorders of Calcium Metabolism and Bone – Pediatric Endocrinology: A Clinical Handbook, 2016 6. Perinatal Calcium and Phosphorus Metabolism – Nephrology and Fluid/Electrolyte Physiology (3rd ed.), 2019 7. Disorders of Calcium and Phosphorus Metabolism – Avery’s Diseases of the Newborn (10th ed.), 2018 8. Disorders of Calcium, Phosphorus, and Bone Metabolism During Fetal and Neonatal Development – ​​Maternal-Fetal and Neonatal Endocrinology, 2020 9. Disorders of Calcium and Magnesium Metabolism – Pediatric Kidney Disease, 2016 10. Disorders of Calcium: Hypocalcemia – Fluid, Electrolyte and Acid-Base Disorders: Clinical Evaluation and Management, 2014 11. Management of Acute Hypocalcemia – Hypoparathyroidism, 2015 12. Hypoparathyroidism in the Differential Diagnosis of Hypocalcemia – The Parathyroids (3rd ed.), 2015 13. Post-Thyroidectomy Hypocalcemia – Thyroid Disease: Challenges and Debates, 2020 14. Acute Postoperative Hypocalcemia After Neck Surgery – Hypoparathyroidism: A Clinical Casebook, 2020 15. Management of Hypocalcemia – Clinical Algorithms in General Surgery: A Practical Guide, 2019 16. Hypocalcemic Crisis: Acute Postoperative and Long-Term Management of Hypocalcemia – Endocrine Emergencies, 2022 17. Management of Post-operative Hypocalcemia – Practical Management of Thyroid Cancer: A Multidisciplinary Approach, 2018 18. Diagnosis and Management of Hypocalcaemia in Adults – Endocrinology and Diabetes: Case Studies, Questions and Commentaries, 2015