scholarly journals The Unusual Suspect: Hypocalcemia in Preeclampsia After Magnesium Infusion

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A227-A227
Author(s):  
Basma Abdulhadi ◽  
Monica Agarwal
Keyword(s):  
Vitamin D ◽  
Magnesium Sulfate ◽  
Parathyroid Gland ◽  
Health Care Providers ◽  
Calcium Gluconate ◽  
Laboratory Evaluation ◽  
Care Providers ◽  
Spot Urine ◽  
Symptomatic Hypocalcemia ◽  
Pth Level

Abstract Background: Magnesium plays a vital role in calcium homeostasis. Magnesium sulfate is used in obstetric populations for the management of preeclampsia and eclampsia. Hypocalcemia secondary to iatrogenic hypermagnesemia is an uncommon complication. We report a case of symptomatic hypocalcemia due to hypermagnesemia. Clinical Case: A 26-year-old female with type 1 diabetes at 33 weeks gestation was admitted for preeclampsia. She had severe hypertension and proteinuria, and the decision to induce labor was made. She was started on a magnesium sulfate drip and remained on the drip for 33 hours. Magnesium levels peaked at 7.5 mg/dL (1.7–2.5 mg/dL). The magnesium drip was suspended after delivery. She complained of mild tingling and numbness in her hands, feet, and perioral area. Shortly after delivery, she had a pre-syncopal event. The laboratory evaluation revealed a calcium of 5.9 mg/dL (8.4–10.4) with an albumin of 2.2 g/dL (3.7–5.5), magnesium of 4.2 mg/dL, phosphorus 2.2 mg/dL (2.3–4.6) and GFR above 60 mL/min/1.73m2 . Spot urine calcium to creatinine ratio was 0.17 mg/dL. The 25-hydroxy vitamin D level was low at 12 ng/mL (20–100). The parathyroid hormone (PTH) level was inappropriately normal at 21.7 pg/mL (12–88). She had no history of hypocalcemia, and calcium level obtained six months before the presentation was normal. She received one calcium gluconate infusion, was then started on a continuous calcium gluconate infusion for symptomatic hypocalcemia. She also received oral supplementation of calcium and vitamin D. The calcium levels normalized within 24 hours as the hypermagnesemia resolved from the discontinuation of the magnesium drip. The subsequent PTH level was 38.8 pg/mL. She was discharged on vitamin D supplements. She had no recurrence of hypocalcemia. Conclusion: Our case highlights the effect of magnesium infusion on the parathyroid gland leading to profound symptomatic hypocalcemia. Magnesium plays an essential role in the secretion of PTH. Transient hypoparathyroidism can occur due to hypomagnesemia and hypermagnesemia (tocolytic therapy). In hypomagnesemia, the parathyroid gland secretes insufficient PTH, and the renal and skeletal response to PTH is reduced. In hypermagnesemia, the magnesium activates the extracellular calcium-sensing receptor, subsequently causing inhibition of the parathyroid gland. Amelioration of hypermagnesemia leads to the normalization of parathyroid function. Health care providers should be aware of this phenomenon, especially in the obstetric population receiving magnesium infusion. The monitoring of calcium levels may be necessary for this patient population. The laboratory testing should include magnesium in the evaluation of hypocalcemia. References: 1. Shoback, D. (2008). Hypoparathyroidism. New England Journal of Medicine, 359(4), 391–403.

The Relevance of Supplemental Vitamin D in Malignancies

2021 ◽  
Vol 21 ◽  
Author(s):  
Delia Nica-Badea ◽  
Aurelian Udristioiu
Keyword(s):  
Vitamin D ◽  
Health Care Providers ◽  
Anticancer Agents ◽  
Scientific Evidence ◽  
Sun Exposure ◽  
Care Providers ◽  
Negative Effects ◽  
Antitumor Effects ◽  
Increased Risk ◽  
Vdr Polymorphisms

Background: Vitamin D has a widely acknowledged role in regulating the metabolism of calcium and phosphate, both essential to bone remodeling. However, numerous studies in recent decades have emphasized the association between low sun exposure and vitamin D deficiency, and an increased risk of extra-skeletal disorders such as cancer. Objective: This mini-review of literature aims to present an objective overview of several recent studies and meta-analyses evaluating the role of vitamin D in cancer prevention, its potential to improve cancer treatment outcomes, as well as the negative effects of vitamin D deficiencies. Methods: The antitumor effects of calcitriol and analogs in the treatment of cancer, either as single agents or in combination with other anticancer agents, are based on several mechanisms: inhibition of cancer cell proliferation and invasiveness, induction of differentiation and apoptosis, and promotion of angiogenesis, all recorded in a number of preclinical studies of several cancer types Results: The importance of VDR polymorphisms for individual malignancies remains a topic of debate. Contradictory effects have been recorded in recent studies, the results of which include positive associations of VDR when cumulated with other risk factors, both an increase and a decrease in cancer risks, as well as no correlation between VDR polymorphisms and individual malignancies.. Conclusion: The scientific evidence reviewed in this paper suggests that health care providers and individuals should consider increasing concentrations of 25 (OH) D through sensitive sun exposure and / or by supplementing with vitamin D to reduce cancer risk and, in combination with standard care, to treat cancer.

Prevalence of Vitamin D Deficiency in Patients With Talar Osteochondral Lesions

2018 ◽  
Vol 39 (4) ◽  
pp. 471-478 ◽  
Author(s):  
Jessica J. M. Telleria ◽  
Lauren V. Ready ◽  
Eric M. Bluman ◽  
Christopher P. Chiodo ◽  
Jeremy T. Smith
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Health Care Providers ◽  
Hypovitaminosis D ◽  
Control Group ◽  
Osteochondral Lesions ◽  
Care Providers ◽  
Mineral Density ◽  
Level Of Evidence

Background: Vitamin D deficiency affects over 1 billion people worldwide and is common in foot and ankle patients. The prevalence in those with osteochondral lesions of the talus (OLTs) is unknown. This study identified the prevalence and risk factors for hypovitaminosis D in patients with an OLT. Methods: Serum 25(OH)D levels were obtained from patients presenting with an OLT from May to November during 2007 to 2016. Hypovitaminosis D was defined as 25(OH)D less than 30 ng/mL (75 nmol/L). Patients presenting with an acute ankle sprain (AS) during the same months served as a control group. Specific medical risk factors for hypovitaminosis D were recorded. The final OLT population included 46 patients (31 women [67.4%]; mean [SD] age 43.6 [14.8] years). The comparison AS group had 40 patients (32 women [80.0%]; mean [SD] age 56.2 [13.0] years). Results: The mean (SD) 25(OH)D in the OLT and AS cohorts were 31.2 (12.6) ng/mL and 37.1 (13.5) ng/mL, respectively ( P = .039). Hypovitaminosis D was identified in 54% of the OLT population and 28% of the AS population ( P = .012). Conclusion: Hypovitaminosis D is intimately related to decreased bone mineral density. This study identified a significantly higher rate of hypovitaminosis D in patients with an OLT compared to a cohort of AS patients. These findings suggest that when patients present with an OLT, health care providers should consider evaluating for and treating hypovitaminosis D. Level of Evidence: Level III, comparative study.

scholarly journals MON-925 A Wolf in Sheep’s Clothing: Intermittent Hypercalcemia from an Intrathyroidal Parathyroid Carcinoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jonathan Trejo ◽  
Lyan Gondin Hernandez ◽  
Joy Wortham ◽  
Brenda Sandoval ◽  
Gustavo R Armaiz-Pena ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Adenoma ◽  
Parathyroid Carcinoma ◽  
Thyroid Tissue ◽  
Laboratory Evaluation ◽  
Thyroid Ultrasound ◽  
Uncommon Presentation ◽  
Sestamibi Scan ◽  
Pth Level ◽  
Benign Thyroid

Abstract Parathyroid carcinomas have an estimated prevalence of <0.1% of all cancers and is found in <1% of patients with primary hyperparathyroidism (PHPT). While they frequently present with PTH- mediated hypercalcemia, they are often distinguished by severe hypercalcemia and markedly elevated PTH levels compared to their benign counterparts. Parathyroid cancers most often arise from existing parathyroid glands, making them identifiable with standard imaging modalities such as parathyroid sestamibi scan, thyroid ultrasound, and 4-D CT scan. There are reports of non-functioning parathyroid carcinomas, including those that are intrathyroidal. Most of the reported cases are found de novo. We present a case of an intrathyroidal parathyroid carcinoma with intermittent hypercalcemia. A 72-year-old man with a history of Graves’ disease and RAI ablation in the 1970’s was found to have hypercalcemia up to 14.1 mg/dL (8.5 - 10.1) with a PTH level of 223 pg/mL (14 - 64). He denied any constipation, bone pain, fractures, renal stones, or changes in mental status. Thyroid ultrasound demonstrated a 3.9 cm R lobe complex nodule reported as TI-RADS 4, and a hypoechoic 1.0 cm nodule in the L lobe. No definitive parathyroid adenoma was reported. A parathyroid sestamibi scan showed persistent uptake in area of the L 1.0 cm nodule favoring a PTH adenoma while the R nodule had initial radiotracer uptake with delayed washout but no technetium uptake. Laboratory evaluation demonstrated a 24-hour urinary calcium of 338 mg/24hr, low 25-OH vitamin D, and normal vitamin D 1,25 levels. Osteoporosis was diagnosed by BMD with T-score of -3.2 at the femoral neck. Repeat serum corrected calcium level was 9.7 mg/dL and PTH was 93 pg/mL. FNA cytology of the R thyroid mass was reported as benign thyroid tissue. Due to size of the R thyroid nodule, the patient underwent a R hemithyroidectomy with L parathyroidectomy. Intraoperative PTH levels decreased from 154 to 120 pg/mL after removal of L parathyroid adenoma; PTH level decreased further to 12.9 pg/mL after R hemithyroidectomy. Surgical pathology revealed 4.5 cm R parathyroid carcinoma without thyroid tissue with positive margins, and a hypercellular L parathyroid gland. PHPT resolved. After review of all aspects of the case and discussion with patient, the decision was made to monitor his calcium and PTH levels and repeat BMD 1 year from resection. This is an uncommon presentation of a rare endocrine malignancy. To our knowledge, there are few case reports of non-functional parathyroid carcinomas that were initially reported as thyroid cancer or benign thyroid tissue after biopsy. This report underscores the importance in keeping this rare diagnosis in the evaluation of PTH-mediated hypercalcemia.

scholarly journals ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING VITAMIN D AMONG STUDENTS OF SAIDU MEDICAL COLLEGE, SWAT

2017 ◽  
Vol 7 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Fazale Haq ◽  
Rukhsana Khan ◽  
Zille Huma Mustehsan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Health Care Providers ◽  
Public Health Problem ◽  
Sunlight Exposure ◽  
The Body ◽  
Care Providers ◽  
Dietary Practices ◽  
Medical College ◽  
Vitamin D Levels

Background: Vitamin D is also known as the “Vitamin of Sun”. More than one billion people are suffering from Vitamin D deficiency globally; it is an epidemic and a very serious global public health problem. In South Asia, Vitamin D deficiency is quite prevalent. Many recent studies have shown that vitamin D helps in preventing cancer, cardiovascular diseases and diabetes.Objectives: To assess the knowledge, attitude, dietary and sunshine practices regarding Vitamin D among students of Saidu Medical College, Swat.Methods: A cross sectional study was carried out among 106 students of Saidu Medical College, Swat. Self-administered questionnaire was distributed to all students and data was analyzed on SPSS 20.Results: Majority of the students 72% had good knowledge of Vitamin D and its synthesis in the body. 91% of the students were aware of the source of Vitamin D and 87.5% knew about sources of vitamin D. However, the  attitude of students towards sunlight exposure was poor as 65.2% students disliked being in the sun, 62.5%  thought that sunlight exposure was harmful for skin, and 65.4% of the students thought that their Vitamin D  levels were sufficient without getting their laboratory tests done.59.6% students used sunscreen in summer.Conclusion: The student's knowledge about Vitamin D was good but their attitude towards sun exposure and dietary practices did not match their knowledge. Medical students, being the future physicians and health care providers, must possess current knowledge about Vitamin D and should also look after their own health and dietary practices.

scholarly journals Prevalence of Vitamin D Deficiency in Patients with Talar Osteochondral Lesions

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0048
Author(s):  
Jessica J.M. Telleria ◽  
Lauren V. Ready ◽  
Eric M. Bluman ◽  
Christopher P. Chiodo ◽  
Jeremy T. Smith
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Health Care Providers ◽  
Hypovitaminosis D ◽  
Control Group ◽  
Osteochondral Lesions ◽  
Care Providers ◽  
Mineral Density ◽  
Medical Risk

Category: Ankle Introduction/Purpose: Vitamin D deficiency affects over 1 billion people worldwide and is common in foot and ankle patients. The prevalence in those with osteochondral lesions of the talus (OLTs) is unknown. This study identified the prevalence and risk factors for hypovitaminosis D in patients with an OLT. Methods: Serum 25(OH)D levels were obtained from patients presenting with an OLT from May to November during 2007 to 2016. Hypovitaminosis D was defined as 25(OH)D less than 30 ng/mL (75 nmol/L). Patients presenting with an acute ankle sprain (AS) during the same months served as a control group. Specific medical risk factors for hypovitaminosis D were recorded. The final OLT population included 46 patients (31 women [67.4%]; mean [SD] age 43.6 [14.8] years). The comparison AS group had 40 patients (32 women [80.0%]; mean [SD] age 56.2 [13.0] years). Results: The mean (SD) 25(OH)D in the OLT and AS cohorts were 31.2 (12.6) ng/mL and 37.1 (13.5) ng/mL, respectively (P =.039). Hypovitaminosis D was identified in 54% of the OLT population and 28% of the AS population (P = .012). Conclusion: Hypovitaminosis D is intimately related to decreased bone mineral density. This study identified a significantly higher rate of hypovitaminosis D in patients with an OLT compared to a cohort of AS patients. These findings suggest that when patients present with an OLT, health care providers should consider evaluating for and treating hypovitaminosis D.

scholarly journals A Study of “Osteoporosis due to lack of Vitamin - D deficiency” through a small Survey in Kolkata, (West Bengal)

2021 ◽  
Vol 9 (4) ◽  
pp. 101-110
Author(s):  
S Rehan Ahmed ◽  
Keyword(s):  
Vitamin D ◽  
Bone Loss ◽  
Health Care Providers ◽  
Bone Health ◽  
Healthy Lifestyle ◽  
The Body ◽  
Care Providers ◽  
Long Term Effects ◽  
Resultant Increase

Bone loss and osteoporosis with the resultant increase in fracture risk should be major concerns for patients and health care providers. As the population ages, the long-term effects of osteoporosis including pain, loss of independence and institutionalized care will become more prevalent. Efforts to prevent bone loss and osteoporosis should start with proper education about a healthy lifestyle, including optimal calcium and vitamin D and exercise in adolescence. This education should continue throughout life, with emphasis during times of increased bone loss such as the menopause transition. This paper reviews the cornerstone of bone health; calcium and vitamin D. Although dietary sources of both nutrients are available, most people do not receive adequate amounts for proper bone health. In addition, the heightened awareness of damaging effects of sunlight has limited vitamin D synthesis from the skin. Fortunately, supplements are available that can supply the body with amounts necessary for bone health.

scholarly journals Atypical Pre-eclampsia With Severe Features: A Case Report

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Abdullahi Abubakar Fakku ◽  
Muhammad Bashir Abdulrahman ◽  
Bello Aminu ◽  
Abubakar Abubakar Panti ◽  
Ibrahim Sambo Aliyu ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Providers ◽  
Rural Areas ◽  
Obstetric Care ◽  
Care Providers ◽  
Unique Case ◽  
Spot Urine ◽  
Obstetric Emergencies ◽  
Maternal Hypertension ◽  
Classical Triad

Background: Many rural areas, especially in developing world, the providers of obstetric care are either family physicians or general practitioners and most of these obstetric emergencies are seen in rural areas. Typical preeclampsia could be easily diagnosed due to it classical triad of maternal hypertension after 20 weeks and before 48 hours post-delivery, proteinuria and oedema. For atypical preeclampsia the diagnosis is usually missed due to its vague nature of presentation. The classical triad features may be absent and hence delayed in the management. Most cases of atypical preeclampsia are associated with high risk of maternal/foetal morbidity and mortality. Objective: The purpose of this case report is to update the knowledge of health care providers on the sundry presentation of atypical preeclampsia. Case summary: This report, describes a unique case of atypical preeclampsia, in which a normotensive primigravida at 37 weeks gestation, presented with severe headache and sudden loss of eyesight, with spot urine protein/creatinine ratio of 1.2, abnormal quadruple analytes (human chorionic gonadotrophin, alpha foetoprotein, inhibin -A and unconjugated oestriol ), platelets count of 96,700 per micro liter and packed cell volume of 24%. Conclusion: Absence of one or two of triad components should not preclude diagnosing preeclampsia, provided there are other features of organs/systems involvement.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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