hi per calc emie

7/25/2019 Hi Per Calc Emie

1/21

V.G. sex M, 16 aniM.I. Varsaturi

Poliurie, polidipsieCasexie, G 15 kg/2 luni

I.B.

Iulie 2000-sete, polidipsie ! l/"i#, poliurie !-5l/"i#

$oie%&rie 2000- 'arsaturi - Int. (p B. In)e*t. +nesti-in)ir%a V

e*e%&rie 2000- 'arsaturi - int. Medi*ala +nesti

poliurie, polidipsie

'arsaturi, G

2 *ri"e o&nu&ilare, tul&urari %ers, e*ili&ru, 'or&ire

pierdere stare *onstienta*on'ulsii toni*e 1 %in

iagnosti* pre"u%ti' ia&et insipid- in)ir%at (p. Paron

Ianuarie 2001- trans)erat 3


2/21

! - 20. 01.2001- 3

*lini*- e'olutie

'arsaturi 10 "ile

*onstipatie - a&senta tran"it 4 "ile

G ! kg polidipsie - ingestie li*ide !000 %l/"i

poliurie- diure"a !000-5000 %l/"i

160/120- 150/110%%g

para*lini*

tul&urari idroele*troliti*e $a7 158%39/l, :7!,1 %39/l,

Cl-114 %39/l, Ca771! %g;

teste in)la%atorii V(


3/21

20.01. 2001 - Internat Pediatrie

ex. *lini*

*asexie G 8< kg

tegu%ente us*ate, pliu *utanat usor lenes, tul&urari tro)i*e *u

des*ua%ari, prurit

de)or%are tora*i*a- stern in)undat

"go%ote *ardia*e asur"ite, rit%i*e V 40/>,

120/=0%%g

a&do%en ex*a'at, nu 'arsa, pri%este ali%ent, *onstipat ($C nor%al

e'olutie

stationare ponderala

nu 'arsa ingestie li*ide 8500-!000%l/"i

diure"a !000-5000%l/"i

115/60 %%G


4/21

Para*lini*

?G - $ r 124 000/%%8#

uree- 68-!


5/21

3x urina

densitate 1010-1015

os%olaritate 224%+s%/l

al&u%ine, glu*o"a- a&sente

Ca771 uro*ultura sterila

(tans)eld-e&&- $

@rogra)ie$

ran"it Ba Irigogra)iedoli*osig%oid

g). oase lungi, *raniu$

Ai&ros*opie gastrita iperpla"i*a

est sudoare- nu transpira C *raniuipo)i"a nor%ala, atro)ie *orti* )rontala, e%is) *ere&el

C paratiroide$

C a&do%inaldistensie i%portanta gastri*a, anse intest, *olon


6/21

EKG


7/21

EKG

Prelungire P 0,16s#BV gr. 1

aplati"at

D* s*urt 0,85s

@nda @


8/21

ECHOGRAFIE PARATIROIDA


9/21

ECHOGRAFIE PARATIROIDA


10/21

DATE SUGESTIVE DIAGNOSTICC?I$IC

se%ne generale astenie

s*adere G

*utanat prurit

digesti' sete, polidipsie,

anorexie, 'arsaturi, (,

*onstipatie renal poliurie

*ardio'as*ular

neurologi* so%nolenta,

o&nu&ilare, tul&urarie*ili&ru, *on'ulsii

PC?I$IC

%odi)i*ari ionogra%a

iper*al*e%ie

ipo)os)ate%ie

os%olaritate *res*uta

ex. urina *al*iurie

xdistensie gastri*a a*uta 3:G BV gr I, s*urtare D,

aplati"are

or%onalP *res*ut

3 3 3V?@

pro&e in)la%atorii po"iti'e

PrimarPrimar


11/21

PTH

Ca++

CT

PTH

Ca++

CT

P ur,

P sg

1,25 +#28

a&s intest Ca77

resor&ie os Ca77

ex*retia renala Ca77

resor&ie os Ca77

a&s intest Ca77

ex*retia renala Ca77

1,25 +#28


12/21

FIIOPATO!OGIE1. Mo&ili"are osoasa ex*esi'a Ca

%etasta"e liti*e osoase, *an*er

osos, %ielo% %ultiplu se*retie *res*uta P

ipertiroidis% 20;#

)eo*ro%o*iro%

I li%)o%

tul&urari %eta&olis% tripto)an

i%o&ili"are

litiu

2. edu*erea eli%inarii Ca

ipotiroidie

insu) *orti*osuprarenala

8. &sor&tie *res*uta Ca

iper'ita%ino"a

iper'ita%ino"a

sindro% lapte-al*aline

sar*oido"a

a*ro%egalie

ad% estrogeni/androgeni

!. Me*anis% %ixt/nepre*i"at

ad% diureti*e tia"idi*e

iper*al*e%ia idiopati*a a

*opilului sdr illia%s %al)#


13/21

ETIO!OGIE " n#$"nas%$&

A+M3 PIMIIV3

ipreparatiroidis%

tran"itor in

ipoparatiroidis% %atern

iperparatiroidis% de)initi'

)a%ilial sau nu

iper*al*e%ie idiopati*a

%ai )re*'. dupa sapt


14/21

ETIO!OGIE" s$'ar, %#(i)A+M3 C@ (P3C EPIMIIVF

1. iperparatiroidis% pri%ar adeno% paratiroidian

*ar*ino% paratiroidian

iperpla"ie *elulara sporadi*a/)a%iliala

neopla"ia endo*rina %ultipla

tip I M3$ I- B. er%ers# adenoa%e ipo)i"are, pan*reati*e,

iperparatiroidis%#

tip II M3$ II- B. (ipple# )eo*ro%*ito%, *ar*ino% %edular tiroidian,

iperparatiroidis%#

tip III M3$ III# *ar*ino% %edular tiroidian, )eo*ro%o*ito%,neurinoa%e %u*oase, aspe*t %ar)anoid, iperpla"ie paratiroidiana#

iperparatiroidis% )a%ilial ipo*al*iuri*


15/21

ETIO!OGIE" s$'ar, %#(i)

A+M3 C@ (P3C EPIMIIVF

2. iperparatiroidis% paraneopla"i*

se*retie de su&stante EP-likeF#

leu*e%ii a*ute

tu%ori extraparatiroidiene in ordinea )re*'entei# *ar*ino%

pul%onar, %a%ar, %ielo% %ultiplu, *ar*ino% in s)era +?,

eso)agian, renal, o'arian, *ol uterin, testi*ular, epati*, li%)o%

li%)o*itar, *olon, pan*reati*, tiroidian, 'e"i*a urinara, *utanat

8. iper*al*e%ii idiopati*e

tip Aan*oni- (*lesinger

tip Aole iper*al*e%ie )a%iliala &enigna#


16/21

A+M3 (3C@$3 EIatrogeneF *au"e )re*'ente

intoxi*atie *u 'it /analogi/%eta&oliti

erori terapeuti*e

utili"are do"e %ari in insu) paratiroidiana, raitis% 'it- re"ist

sensi&ilitate parti*ulara sdr. ?igtHood, sugari ali% *u lapte

in&ogatit in 'it

*au"e putin )re*'ente

i%o&ili"are gipsata prelungita diali"a *roni*a la IC de"' unui iperparatiroidis% tertiar#

*au"e rare

ad%inistrarea diureti*e tia"idi*e

aport prelungit/i%portant lapte7antia*ide sdr. lapte-al*aline Burnett# iper'ita%ino"a

ad% litiu

diete de iperali%entare


17/21

A+M3 (3C@$3- patologi*e

1. ipersensi&ilitate 'it

pneu%onie pneu%o*istis *arinii

sar*oido"a

insu)i*ienta glu*o*orti*oi"i

ipotiroidie

2. )e*tiuni geneti*e

osteopatii disosto"a %eta)i"ara,

ipo)os)ata"ia

)ara a)e*tare osoasa

%ala&sor&tia ereditara tripto)an

E&oala s*lere al&astreF#8. )e*tiuni do&andite *u li"a osoasa

parali"ii extinse *u i%o&ili"are

%etasta"e osoase %ultiple

ipertiroidie

!. Boli endo*rine

ipertiroidie

a*ro%egalie

)eo*ro%o*ito%

insu). suprarenala a*uta

5. Boli in)la%atorii

sar*oido"a

BC

&erilio"a

istoplas%o"a


18/21

TA*!OU C!INICgenerale astenie fizica, oboseala, slabiciune, G, T, prurit

digesti'e anorexie, greturi, varsaturi,constipatie, dureri

abdominale, sete, polidipsie, pancreatita acuta,ulcer, distensie gastrica acuta

neuropsii*e somnolenta, iritabilitate, convulsii, scaderea capconcentrare, memorie, cefalee, ameteli, letargie,dezorientare, confuzie , depresie, halucinatii, ataxie,

tulb vorbire, vaz, auz, retard mental n nasc!neuro%us*ulareosteoarti*ulare

"boseala musculara, chiar pseudoparalizie,hiporeflexie, hipotonie,mialgii, artralgii, exudatarticular, dureri osoase

sdr poliuro-

polidipsi*

#ete, poliurie, polidipsie

*ardio-'as* HT$, bradicardie, tahicardie, %#, &$' gr (,

renale Poliurie, ()$, ()

*al*i)i*ari *eratopatie in banda, ochi rosu, nefrocalcinoza,

litiaza, vasculare


19/21

MODIFICARI EKG

(*urtare D proportional *u *resterea Ca

D* 850-!!0 %s#

aplati"are

unda @

*reste durata PD

BV gr. I

3( 'entri*ulare,

V


20/21

TRATAMENT3 @G3$ Ca 15 %g;

*ore*tarea desidratarii, tul& idro-ele*troliti*e

sol i"otone/ipertone $a *reste *al*iuria prin expansiune ?3C#

Aurose%id 2 %g/kg/8 ore

tJ Core*tia ipo $a7si ipo :7 1,5g :Cl/1000%l (A#

diure"aK 1-2 l/ora

Cal*itonina 2 u/kg/4 ore Celatori Ca - Cal*iu% 3 3deta%in# i' lent

Aos)at I.'. 20-80 %g )os)or /kg a*t 12-1< ore#/ Bi)os)onati

Galliu% nitrat I.'. la %etasta"e osoase#

diali"a peritonela paratiroide*to%ie

%itra%*ine/Pli*a%i*ina 25g/kg P3V la adult %axi% ! "ile

M3$ 3 ?@$G @


21/21

M3$ 3 ?@$G @

I3 ipo*al*i*a ex*lus lapte, gal&enus ou, nu*i, alune, )asole, %a"are

3I+?+GICIdeal *irurgi*al, %o&ili"are, sistare aport#

P+G3$IC

*resterea ex*retiei de Ca

)urose%id, solutii saline

*elatori Ca- 3 *ure inter%itente

di%inuarea a&sor&tiei de Ca

*orti*oterapie 1%g/kg/"i 80 "ile

)os)ati s*ad a&sor&tia# 1,5-8g/"i

*resterea )ixarii osoase

)os)ati *al*iu p.o. 0,25-2 g/"i, potasiu, sodiu p.o. 2-! g/"i

*al*itonina !u/kg s.*. la 12-2! ore

estrogeni *onLugati 0.

hi per calc emie

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