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Electrolyte Disorders (Calcium, Magnesium, Phosphate) — Written Clinical Reasoning
DCE long-case preparation: structured written reasoning for divalent ion scenarios — severe hypercalcaemia with suppressed PTH in myeloma, and acute post-thyroidectomy hypocalcaemia.
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FRACP DCEMRCP Part 2
Prompt
DCE long-case preparation: structured written reasoning for divalent ion scenarios — severe hypercalcaemia with suppressed PTH in myeloma, and acute post-thyroidectomy hypocalcaemia.
SAQ — Divalent ion emergencies (20 marks, 30 minutes)
Prompt: Answer both parts, addressing the mechanism, immediate management with doses, workup, and follow-up. Justify each decision with reference to evidence. [1]
Case vignette Part A: A 68-year-old man with known myeloma presents with confusion. Corrected calcium 3.4 mmol/L, suppressed PTH, acute kidney injury with vomiting and poor intake. [1]
Case vignette Part B: A 54-year-old woman 30 hours after total thyroidectomy develops perioral paraesthesia and hand cramps. [1]
References5ShowHide
- [1]Minisola S, Pepe J, Piemonte S, et al. The diagnosis and management of hypercalcaemia BMJ, 2015.PMID 26037642
- [2]Major P, Lortholary A, Hon J, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials J Clin Oncol, 2001.PMID 11208851
- [3]Hu MI, Glezerman IG, Leboulleux S, et al. Denosumab for treatment of hypercalcemia of malignancy J Clin Endocrinol Metab, 2014.PMID 24915117
- [4]Brandi ML, Bilezikian JP, Shoback D, et al. Management of Hypoparathyroidism: Summary Statement and Guidelines J Clin Endocrinol Metab, 2016.PMID 26943719
- [5]Bollerslev J, Rejnmark L, Marcocci C, et al. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults Eur J Endocrinol, 2015.PMID 26160136