By Vikas Bhushan
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Extra info for Blackwell's underground clinical vignettes. Biochemistry
HPI Very high blood pressure has been recorded at the time of previous paroxysms. The patient has a good appetite but looks cachectic; blood pressure recorded between paroxysms is normal. The patient has no history suggestive of renal disease. PE Labs Imaging VS: hypertension (BP 180/120). PE: hypertensive retinopathy changes on fundtiscopic exam. Elevated blood sugar (due to increased catecholamines). Lytes: normal. Increased 24-hour urinary free catecholamines and vanillylmandeUc acid (VMA) levels.
ECG: p r o l o n g e d P-R a n d Q-T intervals; wide Q R S ; tall T waves; p r e m a t u r e ventricular ectopic contractions. Treatment Magnesium s u p p l e m e n t a t i o n. Hypokalemia a n d hypocalcemia resolve with magnesium replacement . Discussion Homeostasis of magnesiu m is achieved t h r o u g h a balance between intestinal (small bowel) absorption a n d urinary excretion. is diuretics, cisplatin, inethi >u exate, amphotericin B, Ciclosporine a n d aminoglycosides. HYPOMAGNESEMIA ID/CC A 37-year-old white female complains of nausea, vomiting, and headache on h e r first postoperative day: the charge m u s e found her having a g r a n d mal seizure.
XR, hip: surgical neck femoral fracture. XR, lumbal- spine: collapse of lumbar vertebrae; generalized osteopenia; pseudofractures (appearance of nondisplaced fractures representing local bone resorption). Excess osteoid but poor mineralization. Treatment Vitamin D, calcium (and sometimes phosphate) supplements; surgical treatment of fracture, physiotherapy. Discussion A poor diet in vitamin D and calcium, lack of sunlight exposure, intestinal malabsorption, renal insufficiency, or target organ resistance may lead to osteomalacia in the adult (or rickets in children), with defective calcification of osteoid.