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Jamie
Calcium Metabolism
Adj Ca > 2.8 Adj Ca > 3.5 Life threatening……Bleep Med Reg..
Measure PTH
PTH PTH detectable
undetectable or high…
Hypercalciuria
Absorptive
Resorptive
Hypercalciuria Renal Leak Hypercalciuria
hypercalciuria
(Type I and II)
Decreased dietary
calcium leads to decreased Obligatory renal Loss Almost always
Urinary calcium hyperparathyroidism
In clinical practice types 1 and 2 often overlap and distinguishing between them
seems like intellectual masturbation as it does not affect therapy as far as I can see
but am prepared to be shot down…
Treatment Options: Diet
• Limit calcium to 600 – 800 mg daily
• Reduce dietary oxalate levels
• Avoid excessive animal protein (<1.7 g /kg/day)
• Reduce sodium intake
• Increase dietary fiber (12 – 24 g/ day)
• Limit ETOH and Caffine
• Increase fluid intake to manage 2 l urine / day
Treatment Options: Pharmacology
• Absorptive (Type 1)
– Thiazides:
– Orthophosphates (reduce Vit D)
– Calcium Binding Agents (Sodium Cellulose
Phosphate)
• If using SCP then restrict dietary oxalate (as free
intestinal calcium is the natural intra intestinal binding
agent so … SCP can lead to hyperoxaluria.
Hypercalciuria and stone formation