tailieunhanh - CURRENT ESSENTIALS OF CRITICAL CARE (PART 3)

Canxi huyết thanh [Ca2 10,5 mg / dL (hiệu chỉnh về albumin) hoặc ion hóa canxi cao Biếng ăn, buồn nôn, nôn mửa, adynamic tắc ruột, táo bón, đau bụng, viêm tụy trạng thái tinh thần bị biến đổi với sự thờ ơ, obtundation, hôn mê, rối loạn tâm thần | This page intentionally left blank Chapter 5 Fluids Electrolytes Acid-Base 53 Hypercalcemia Essentials of Diagnosis Serum calcium Ca2 mg dL corrected for albumin or elevated ionized calcium Anorexia nausea vomiting adynamic ileus constipation abdominal pain pancreatitis Altered mental status with apathy obtundation coma psychosis Polyuria polydipsia nephrocalcinosis impaired urinary concentrating ability Band keratopathy of eyes Increased risk of bone fractures ECG with shortened QT interval cardiac arrhythmias especially in patients on digitalis Differential Diagnosis Malignancy Thiazide diuretics Thyrotoxicosis Immobilization Hyperparathyroidism Vitamin A or D intoxication Milk-alkali syndrome Adrenal insufficiency Paget disease of bone Familial hypocalciuric hypercalcemia Granulomatous diseases sarcoidosis tuberculosis fungal in- fections Treatment Aggressive fluid resuscitation with normal saline Once euvolemic loop diuretics to induce calciuresis avoid thiazides Calcitonin useful with life-threatening hypercalcemia in initial phase of therapy due to rapid onset of action but transient effect Bisphosphonates lower calcium over several days Glucocorticoids effective in steroid-sensitive malignancy granulomatous disease vitamin D induced hypercalcemia Hemodialysis Evaluate for underlying etiology especially malignancy Pearl The serum calcium level should be corrected according to the patient s albumin level based on the following calculation calciummeasured X 4 albumin . Reference Fukugawa M et al Calcium homeostasis and imbalance. Nephron 2002 92 41. pMiD 12425329 54 Current Essentials of Critical Care Hypocalcemia Essentials of Diagnosis Serum calcium Ca2 mg dL corrected for albumin or reduced ionized calcium Correction for albumin calciummeasured X 4 albumin Symptoms correlate with rapidity and magnitude of fall Tetany paresthesias hyperreflexia most common manifestations acute hyperventilation may evoke tetany Altered mental status seizures .