醫學筆記匯整 ED Notes

• Chvostek's signs：敲 Facial nerve, 因神經過於敏感, 嘴角會抽動
   
• Trousseau' s signs：綁上壓脈帶後, 給予大於SBP的壓力
                                        會出現 Carpal spasm 
   

1. Acute, moderate hypocalcemia : 
    Circumoral or distal paresthesias and tetany

2. Acute, severe hypocalcemia : 

• Laryngospasm, confusion, seizures
• Bradycardia  
• Decompensated heart failure.

 低血鈣 : 

• A serum calcium < 8.4 
  with a normal serum albumin 
   
• Ionized calcium <4.2 

D/D : 

(1) Pseudohypocalcemia : 因為 albumin 低, 其實沒事

(2) Hypoparathyroidism :
       Reduced PTH acitivity
       Autoimmune, Infiltrative, Iatrogenic ( Postthyroidectomy)

(3) Hypomagnesemia :
      低血鎂 (<1 mg/dL) & 嚴重高血鎂 (>6 mg/dL)
      impaired release of PTH 

(4) Vit D deficiency : 除非很嚴重, 不然很難影響到血鈣

(5) Other- binding : 
      1. Profound elevations in serum phosphorus
      2. Be bound by Citrate : 輸血
      3. Drug : Foscarnet and Fluoroquinolones
      4. Increased binding to albumin

(6) Other-critically ill patient
 

(1) Ca -PTH axis
(2) Mineral abnormalities
(3) Albumin
(4) Serum PTH
      - Low serum PTH : hypoparathyroidism
      - High PTH : Vitamin D deficiency, PTH resistance, Hyperphosphatemia

(5) Serum phosphorus
(6) Vitamin D : Only need to measure 25(OH)D3 
(7) Mg

* 先測 P :
 

• P 高 排除 CKD 的鈣低磷高
  再來 PTH 低就是 Hypoparathyroidism 
   
• P 低, 測尿鈣, 往 Vit D deficiency 走
   

• Symptomatic : Ca gluconate ( 1-2 g IV ) + Calcitriol ± Mg ( 50-100 mEq /d )
• Asymptomatic or Chronic : Oral Ca ( 1-3 g/d ) + Vit D
• Chronic renal failure : Phosphate binder, Oral Ca, Calcitriol

- 嚴重高血磷, 給鈣可能會造成鈣磷沉積
- IV calcium for severe or symptomatic hypocalcemia 
- Ca gluconate ( 1-2 g IV ) mixed in 50 to 100 mL of D5W over 10 to 20 minutes