Hypercalcemia

Description:

Hypercalcemia - increase in concentration of calcium in serum or a blood plasma over 2,5 mmol/l.

Hypercalcemia symptoms:

Weakness, polydipsia, polyuria, nausea, vomiting, the increase in the ABP which is replaced at development of dehydration by hypotonia and further by a collapse, block and a stupor are inherent to an acute hypercalcemia. At a chronic hypercalcemia the neurologic symptomatology is expressed not so sharply. The polyuria and as a result a polydipsia develop because of decrease in concentration ability of kidneys owing to disturbance of active transport of the sodium proceeding with the participation of Na-K-Atfazy from the ascending nephronic loop knee in an interstitium and washing away of sodium from a medulla therefore the kortiko-medullary gradient of sodium decreases and the reabsorption of osmotically free water is broken. At the same time permeability of distal tubules and collective tubules for water decreases. Reduction of volume of extracellular liquid strengthens a reabsorption of bicarbonate and development of a metabolic alkalosis is promoted, and by increase in secretion and excretion of potassium - a gipokaliyemya

At it is long the existing hypercalcemia find intersticial fibrosis at the minimum changes in balls in kidneys. As intrarenal concentration of calcium increases from bark to a nipple, at a hypercalcemia loss of crystals of calcium is observed preferential in marrow, causing a nephrocalcinosis and a nephrolithiasis. As other clinical manifestations of damage of kidneys at a hypercalcemia serve the uric syndrome (a moderate proteinuria, an erythrocyturia), a prerenalny azotemia owing to dehydration, OPN and HPN as an outcome of obstructive pyelonephritis.

Hypercalcemia reasons:

Hypercalcemia reasons:
    * Primary hyperparathyreosis
    * Malignant new growths
    * Humoral hypercalcemia
    * A local osteolytic hypercalcemia (e.g., at a myeloma, metastasises)
    * Hyperthyroidism
    * Granulematozny diseases (sarcoidosis)
    * Medicinal hypercalcemia
    * Vitamin D overdose
    * Milk and alkaline syndrome
    * Thiazide diuretics
    * Lithium
    * Immobilization (Pedzhet's disease)
    * Family hypocalciuric hypercalcemia
    * HTLV-1 an infection can be shown by a heavy hypercalcemia
    * Pheochromocytoma (multiple endocrine adenomatosis of the II type)

Treatment of the Hypercalcemia:

Treatment of a hypercalcemia: elimination of the reason of a hypercalcemia (an oncotomy, the termination of reception of vitamin D and t of), reduction of intake of calcium in an organism, increase in its removal, purpose of the means interfering a calcium exit from bones, and the drugs strengthening intake of calcium in a bone. The most important components of treatment - recovery of volume of extracellular liquid. - 3 l of isotonic solution of sodium of chloride a day under control of the central venous pressure) and correction of electrolytic composition of plasma. Furosemide (100 - 200 mg intravenously each 2 h) strengthens calcium excretion while tiazida have opposite effect. At intravenous administration of phosphates (Na2 HPO4 or NaH2PO4) calcium level in plasma also decreases, however phosphates are contraindicated at a renal failure. A resorption of a bone tissue the calcitonin, glucocorticosteroids oppress. Decrease in level of calcium in plasma begins in several hours after introduction and reaches a maximum for the 5th day of treatment. Mitramitsin causes thrombocytopenia, damage of a liver and has to be used in the absence of effect of other treatment. For the emergency decrease in content of calcium in blood use of a hemodialysis or peritoneal dialysis with a beskaltsiyevy dialysis fluid is possible (it is put generally at patients with the accompanying heart and renal failure into practice). At the tumoral hypercalcemia connected with excess products of PGE 2 (metabolites are found in urine), indometacin and other inhibitors of synthesis of prostaglandins give gipokaltsiyemichesky effect. The hypercalcemia accompanying a thyrotoxicosis is quickly stopped by purpose of propranolol intravenously in a dose of 10 mg/h. Glucocorticosteroids do not exert impact on a hypercalcemia at primary hyperparathyreosis therefore the test with a hydrocortisone is used for the differential diagnosis of a hypercalcemia.