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Hypercalcemia;  Approach to the diagnosis Wisit Cheungpasitporn, M.D. Phang-Nga Hospital, Thailand
CALCIUM PHYSIOLOGY:  BLOOD CALCIUM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CALCIUM PHYSIOLOGY: BLOOD CALCIUM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CALCIUM HOMEOSTASIS DIETARY CALCIUM INTESTINAL ABSORPTION ORGAN PHYSIOLOGY ENDOCRINE PHYSIOLOGY DIETARY HABITS,  SUPPLEMENTS BLOOD CALCIUM BONE KIDNEYS URINE THE ONLY “IN” THE PRINCIPLE “OUT” ORGAN PHYS. ENDOCRINE PHYS. ORGAN, ENDOCRINE
CALCIUM HOMEOSTASIS
FUNCTION OF VITAMIN D ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VITAMIN D SYNTHESIS SKIN LIVER KIDNEY 7- DEHYDROCHOLESTEROL VITAMIN   D 3   VITAMIN D 3   25(OH)VITAMIN D h  25-HYDROXYLASE 25(OH)VITAMIN D 1,25(OH) 2  VITAMIN D ( ACTIVE METABOLITE ) 1  -HYDROXYLASE TISSUE-SPECIFIC VITAMIN D RESPONSES
 
PTH and C alcitonin ,[object Object],[object Object],[object Object]
PARATHYROID   HORMONE (PTH) PHYSIOLOGY ,[object Object],[object Object],[object Object],[object Object]
 
CALCIUM, PTH, AND VITAMIN D FEEDBACK LOOPS NORMAL   BLOOD Ca RISING  BLOOD Ca FALLING  BLOOD Ca SUPPRESS PTH STIMULATE PTH BONE RESORPTION URINARY LOSS 1,25(OH) 2  D PRODUCTION BONE RESORPTION URINARY LOSS 1,25(OH) 2  D PRODUCTION
 
[object Object],[object Object],[object Object],[object Object],[object Object],Hypercalcemia
[object Object],[object Object],[object Object],Severity
[object Object],[object Object],[object Object],Pathophysiology
[object Object],[object Object],CAUSES
[object Object],[object Object],[object Object],[object Object],[object Object],CAUSES
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CAUSES
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CAUSES
[object Object],[object Object],[object Object],[object Object],[object Object],CAUSES
CAUSES ,[object Object],[object Object],[object Object],[object Object],Approx.  80% of all cases are caused by  Malignancy or Primary Hyperpathyroidism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary hyperPTH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Primary hyperPTH
Cancer ,[object Object],[object Object],[object Object]
HYPERVITAMINOSIS D ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HYPERVITAMINOSIS D: CLINICAL CHARACTERISTICS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NON-HORMONAL HYPERCALCEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RENAL FAILURE-ASSOCIATED HYPERCALCEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DRUG-INDUCED HYPERCALCEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object]
DRUG-INDUCED HYPERCALCEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object]
DRUG-INDUCED HYPERCALCEMIA ,[object Object],[object Object],[object Object],[object Object]
Clinical  ( >12 ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs and Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Approach ,[object Object],[object Object],[object Object],[object Object],[object Object]
Approach ,[object Object],[object Object],[object Object]
Approach ,[object Object],[object Object]
Approach ,[object Object],[object Object],[object Object],[object Object]
Approach ,[object Object],[object Object],[object Object]
Approach
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Approach
Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Management ,[object Object],[object Object]
 
Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calcitonin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bisphosphonates ( Alendronate  ไม่ลด ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Glucocorticoid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Phosphate ,[object Object],[object Object],[object Object]
PARATHYROIDECTOMY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Hypercalcemia; How to approach

  • 1. Hypercalcemia; Approach to the diagnosis Wisit Cheungpasitporn, M.D. Phang-Nga Hospital, Thailand
  • 2.
  • 3.
  • 4. CALCIUM HOMEOSTASIS DIETARY CALCIUM INTESTINAL ABSORPTION ORGAN PHYSIOLOGY ENDOCRINE PHYSIOLOGY DIETARY HABITS, SUPPLEMENTS BLOOD CALCIUM BONE KIDNEYS URINE THE ONLY “IN” THE PRINCIPLE “OUT” ORGAN PHYS. ENDOCRINE PHYS. ORGAN, ENDOCRINE
  • 6.
  • 7. VITAMIN D SYNTHESIS SKIN LIVER KIDNEY 7- DEHYDROCHOLESTEROL VITAMIN D 3 VITAMIN D 3 25(OH)VITAMIN D h  25-HYDROXYLASE 25(OH)VITAMIN D 1,25(OH) 2 VITAMIN D ( ACTIVE METABOLITE ) 1  -HYDROXYLASE TISSUE-SPECIFIC VITAMIN D RESPONSES
  • 8.  
  • 9.
  • 10.
  • 11.  
  • 12. CALCIUM, PTH, AND VITAMIN D FEEDBACK LOOPS NORMAL BLOOD Ca RISING BLOOD Ca FALLING BLOOD Ca SUPPRESS PTH STIMULATE PTH BONE RESORPTION URINARY LOSS 1,25(OH) 2 D PRODUCTION BONE RESORPTION URINARY LOSS 1,25(OH) 2 D PRODUCTION
  • 13.  
  • 14.
  • 15.
  • 16.
  • 17.
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Editor's Notes

  1. Dehydration decreases renal calcium excretion and patients take in less fluids b/c of n/v. HYPERCALCEMIC CRISIS –; severe hypercalcemia- high ca 13-15, volume depletion, and altered mental status.