nbme2 Ca and PO4 q - quansar

[ArchivalUser]

. A 10-year-old boy is brought to the physician
because of weakness and decreased appetite for 3 months. He
weighs 30 kg (66 lb) and is 142 cm (56 in) tall; he has had a 2.3-kg (5-lb) weight loss since his last examination 6 months ago. He appears thin. Deep tendon reflexes are brisk. Chvostek's sign is positive. His serum calcium level is 6.5 mg/dL, and serum intact parathyroid hormone level is 190 pg/mL (N=9“65). In addition to calcium supplementation,
which of the following is the most appropriate next step in management?

A) Oral phosphate supplementation
B) Oral vitamin D supplementation
C) Intranasal calcitonin therapy
D) Parenteral bisphosphate therapy
E) Parenteral parathyroid hormone therapy

This pt might have CF such that Vd can not be absorbted properly----leads to low Ca and Po4

Now oral Vd supplementation won't help because he has problem absorbing it..

any inputs?? CF dx is not so sure though coz he has no past history supporting it

[ArchivalUser]

looks like malabsorption-->vitamin D def..ans B..along with it identify the cause and treat it..if CF,then with pancreatic enzymes..

[ArchivalUser]

I agree with Romeo

[ArchivalUser]

WELL the problem is in GI so only oral Vd won't help, unless you are giving it along with pancreatic enzyme

On the other hand, how about A.... the pt will have low Phosphate too due to low Vd

[ArchivalUser]

well..to me...it seems more like chronic renal problem....the only symptom is loss of appetite and weakness...which can very well be a feature of CRF.....vit D deficiancy leading to hypocalcemia and secondary hyperparathyroidism.....since the primary problem is Vit D deficiancy...I will go for BBBBBBBBBB

[ArchivalUser]

hi, darkhose. Good to see you here...

Why do you think he (a 10 y/0 pt) has chronic renal problem....no clue in the q stem...

yes he did have secondary hyperparathyroidism, which could be secondary to low Vit D and low Ca ....

[ArchivalUser]

there is no clue for anything else as well.....nothing to point GI as well..just a guess...bcoz chronic renal problem can present with loss of appetite and weakness....there may be other reasons for the same....but one thing correct here is...its secondary hyperparathyroidism due to hypocalcemia...may be due to vit D def....

[ArchivalUser]

renal failure would be the cause of Vit D deficiancy

[ArchivalUser]

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