hypercalcemia - it polietiologichesky pathology observed in a symptom of other diseases or self nosology, which is based on a sharp or moderate increase in calcium concentration in the serum.
Due to the fact that this pathological condition belongs to the category of clinical and laboratory changes to the fore as a diagnostic event is the study of blood on the saturation level of blood calcium, as well as instrumental imaging (ray diagnostic techniques).
clinical picture of this disease have a direct relationship with the degree of increase in the concentration of calcium and age of the patient.The basis of the therapeutic measures hypercalcemia include stimulation of excretion of calcium from the body by conservative methods, as well as preventing a possible bone resorption.
Causes of hypercalcemia
main link etiopathogenesis hypercalcemia is excessive destruction of bone structure of a particular location, which can occur at various pathologies (osteoclastic type of me
Another common mechanism of hypercalcemia is to increase the absorption of calcium in the jejunum, which occurs in milk-alkali syndrome and sarcoidosis.Also, the mechanism of hypercalcemia observed in patients taking long-term medications that contain calcium (antacids in diseases of the gastrointestinal profile).
In addition to these factors of great importance in the development of hypercalcemia has functioning of the urinary system, becausethe oppression of the excretory process a delay of calcium in the blood.
Symptoms and signs of hypercalcemia
initially characterized by hypercalcemia latent course, in which the patient does not arise any pain or symptoms are so nonspecific that the patient can not recognize the reason for their occurrence.At this stage of the disease should be classified as accidental findings during screening laboratory examination of the patient.
in more patients with hypercalcemia varying degrees of severity, complain of various diarrheal disorders (nausea, anorexia, heartburn).During the expanded clinical hypercalcemia manifested symptoms of intestinal obstruction (long-term constipation, flatulence, spasmodic pain in the projection of the abdominal cavity without precise localization).Due to the existing reversible changes in renal concentrating mechanisms, the patient may experience polydipsia, polyuria and nocturia, wearing a short-term transitory nature.
In a situation where the patient has hypercalcemia with a significant increase in the concentration of calcium in the body, develop severe clinical symptoms that require immediate medical intervention.The patient becomes emotionally labile, and in the advanced stage marked various degrees of impaired consciousness somnobulentsii coma.Patients concerned about generalized muscle weakness, inability to perform familiar exercise, but convulsions in this condition is extremely rare.
Prolonged hypercalcemia is always accompanied by transient or chronic renal failure due to form a plurality of microcalcifications in the thickness of the renal parenchyma.It must be remembered that infringement of the urinary function of the kidneys, stimulates the development of a patient with a malignant hypercalcemia resistant hypertension, which in some cases is the only clinical manifestation of the disease.
If hypercalcemia occurs against a background of hyperparathyroidism, the patient has a tendency to chronic ulcers and symptoms of acute pancreatitis.Prolonged heavy hyperthyroidism accompanied by the development of fibrous generalized bone disease, which is characterized by increased osteoclast activity and, consequently, the formation of fibrous areas of cystic degeneration and bone reconstruction of various localization.Risk category for this disease are patients with renal failure who are on long dialysis, and patients with secondary hyperparathyroidism form.Laboratory confirmation of fibrous osteodystrophy is a significant increase in serum alkaline phosphatase indicator.
statistics prove the possibility of fatal hypercalcemia.Death occurs during the development of shock and acute renal failure.
hypercalcemia in children
hypercalcemia refers to a form of violation of mineral metabolism and the incidence of this disease in comparison with hypocalcemia is significantly lower, but despite this fact, this pathology in childhood always runs hard and needs immediate medicalcorrection.
emergence of those or other clinical manifestations of hypercalcemia depends on the patient's age and the degree of saturation increase serum calcium.For different age groups characterized by the development of different forms of this disease, which are fundamentally different nature of hypercalcemia and consequently approaches to its treatment.
Thus, the neonatal period is considered to be critical of the development of Williams syndrome, which in pediatrics has a second name "idiopathic hypercalcemia."The cause of this disease is a congenital genetic mutation, and the main pathogenetic mechanism of hypercalcemia is to increase calcium absorption in the small intestine.
Given the experience of long-term monitoring of patients suffering from idiopathic hypercalcemia was determined classic triad of clinical features: a sharp mental retardation, coarse vascular abnormalities and changes in the facial region of the skull with the formation of phenotypic "pixie face."Over time, children with this form of hypercalcemia largely manifested cognitive and intellectual disorders.
Unfortunately, at the moment it was not possible to develop diagnostic methods for determining signs of Williams syndrome in utero.The main therapeutic interventions for this disease is to limit the daily intake of a child of calcium, as well as compliance with a specific diet of the mother during lactation, the control of dosing solution of vitamin D, and only in severe permitted the appointment of glucocorticosteroid therapy (hydrocortisone at a daily dose of 10 mg per 1 kgthe weight of the child).
also a congenital form of hypercalcemia is heterozygous family type that is different benign course and the lack of specific clinical symptoms, allowing for earlier diagnosis of the disease state.
Family hypercalcemia is often a random finding during routine screening laboratory examination of the child and does not require medical treatment.
Gipokaltsiuricheskaya hypercalcemia is classified as urgent conditions requiring immediate medical intervention, because this pathology is characterized by rapidly progressive aggressive course.The manifestations of this form of hypercalcemia is observed immediately after birth, and are in the development of gross congenital abnormalities of the skeleton, severe delay physical and mental development of the newborn.Besides critically high levels of calcium in blood serum biochemical laboratory criteria for this disease include increasing PTH concentration and a significant decrease in urinary calcium levels.Because gipokaltsiuricheskaya hypercalcemia in most cases have a poor outcome, the children immediately after birth is recommended to perform the removal of the parathyroid glands with simultaneous autologous transplantation site parathyroid tissue to muscle array forearm.Long-term rehabilitation treatment is the use of calcium-containing medicines and vitamin D. solution
nonspecific forms of hypercalcemia, which is observed as the adult patient population and among children is immobilization.This pathology is caused by demineralization of bone in areas, long located in the immobilized position in severe multiple trauma and thermal injuries.In this regard, the most effective way to prevent the development of symptoms of hypercalcemia in these patients is the activation of early rehabilitation period.When existing signs immobilization hypercalcemia good effect has an adequate scheme of diuretic therapy (furosemide calculated 1 mg / 1 kg body weight of the child intravenously).
Failure Mode reception of synthetic drugs of vitamin D, which is used both as a warning and a therapeutic agent in breast period, the conditions for the development of signs of hypercalcemia.In this situation, the original event is the immediate cessation of the drug containing vitamin D, as well as correction of the child's eating behavior, implying abstinence from foods containing calcium.
treatment of hypercalcemia
volume of necessary medical measures depends on the degree of concentration of serum calcium, as well as the existing background of the disease, which has become the primary cause of hypercalcemia.
Diet hypercalcemia belongs to the category of minor conservative methods of treatment, and in a difficult situation have to be supplemented by a number of medical drugs.
In cases where the patient shows a sharp increase in the concentration of calcium in the blood serum, as well as in severe hypercalcemia, you must urgently use medical methods of correction.
When a patient does not show signs of impaired renal function, it is advisable to use intravenous infusion of sodium chloride, the effect of which is aimed at stimulating kaltsiurii.Effective is the infusion at which the amount of daily urine output of at least three liters.After the introduction of 0.9% solution of sodium chloride in a volume of two liters, necessary to stimulate diuresis by use of diuretic drugs series (Furosemide 80 mg parenterally periodicity every 8 hours and not less than 2 days).Mandatory charts diuretic therapy is the use of drugs, potassium chloride, the effect of which is aimed at preventing possible hypokalemia.
In a situation where there is a severe form of hypercalcemia in patients on the background of existing renal failure, the maximum and has a rapid effect hemodialysis method that involves using a solution containing calcium in a minimal amount.The drug of choice in this situation is a potassium phosphate and sodium, which is in a volume per dose by intravenous administration method eliminates the manifestations of hypercalcemia over two weeks.This technique should be used with caution, as it has a number of adverse reactions, the most frequent is the formation of calcifications in the soft tissues, especially at the injection site.
patients with hypercalcemia paraneoplastic genesis mithramycin recommended to apply a daily dose of 25 mg / 1 kg body weight of the patient by intravenous injection.But keep in mind that this drug is classified as highly toxic drugs that is why you need to carefully dispense the drug administered.
in the treatment of chronic forms of hypercalcemia should be preferred salmon calcitonin in the maximum daily dose of 8 IU / 1 kg of body weight subcutaneously or prednisone in a daily dose of 60 mg orally.These drugs are used for the relief of severe paraneoplastic hypercalcemia if the use of sodium chloride did not have a proper positive effect.Calcitonin analogue with greater efficacy in correction of hypercalcemia is gallium nitrate at a dose of 200 mg, the effect is in some cases more than 15 days.Because the drug has a wide range of adverse reactions, including the development of signs of acute renal failure, its scope is severely restricted with the aim of taking a one-time relief of the acute phase of hypercalcemia.
As a preparation for the prolonged treatment of hypercalcemia should use neutral phosphate oral solution.The only contraindication to its use is a severe degree of renal failure.
In the case of hyperparathyroidism hypercalcemia on the background of having a progressive course, shows the use of surgical methods.Certain difficulties could make the detection of localization of parathyroid tissue, which are different ray imaging techniques, but most confident in this situation has a method of computer tomography.This operation is considered successful if the concentration of serum calcium to normal within 24 hours.