PowerPoint bemutató - Osteoporosis

PowerPoint bemutató - Osteoporosis

ANYAGCSERE CSONTBETEGSGEK 2003 SE OK I. Belklinika Hypercalcaemia Differencildiagnosztika, Kezels Dr Nagy Zsolt SE I.sz.Belklinika Norml calcium hztarts Tpllk 20mmol Absorptio 11mmol Szklet 14mmol Formatio 6mmol ECF

Secretio 5mmol Filtrlt 200mmol Resorptio 6mmol Reabsorptio 194mmol Vizelet 6mmol A szrumban kering kalcium megoszlsa Fehrjhez kttt 47 % albuminhoz 37 % globulinhoz 10 % Ultrafiltrlhat 53 % Ionizlt Ca

47.5 % Komplexben kttt 5.5 % Bikarbonthoz 2.5 % Foszfthoz 1.5 % Citrthoz 1.5 % Az ionizlt s az sszCa szint kzti arnytalansg okai: Eltrsek az albumin koncentrciban Globulinhoz kttt Ca Ca-citrt complexek Gadolinium PH eltrsek Hypercalcaemia: sszCa 2.60 mmol/l ionizlt Ca 1.30 mmol/l felett A hypercalcaemia szindrma Gastrointestinalis: tvgytalansg,hnyinger,hnys, obstipatio, szomjsg, polydipsia, pancreatiris, ulcus Renalis: polyuria, vesek, nephrocalcinosis, beszklt vesemkds

Neuropszichitriai: cskkent koncentrlkpessg, aluszkonysg, zavartsg, nyugtalansg, szemlyisgvltozs, depresszi, coma ltalnos: fradtsg, izomgyengesg iCa iPTH M. iCa + iPTH iCa M. PTH-rP M. CaE PTH-rP CaE<30 CaE<30 iPTH<2x iPTH<2x

Csald vizsglat PTH-rP N/Cs M. 25D/1,25D vit HHM FHH ,iPTH 25/1,25D N M.Csont rezorpci PHPT Mal. Osteolysis lithium Immobilizti

Thyreotoxicosis 25/1,25D Vit. D medilt Tejalkli sy. Hypercalcaemia okai 1 A. Parathyroidfgg PHPT FHH Lithium carbonat Veseelgtelensg, transzplantci MEN B. Parathyroid-

fggetlen 1. Malignus okok PTHrP medilt Ltikus csont metasztzisok. 1,25 D vitamin medilt (lymphoma,T-sejt leukmia Hypercalcaemia okai 2 benignus okok Endokrin Thyreotoxicosis, Pheocromocytoma Mellkveseelgtelensg, VIP Osteoclast medilt Immolizici, Totl parenterlis tplls

Gygyszer medilt Vitamin A Thiazidok sztrogn/Tamoxifen Aminophyllin Nvekedsi hormonok Foscarnet Tej-alkli sy. Hyperabsorptv Dvit. Intox.

Nem fertz granulomatosus 1. 2. 3. Sarcoidosis Berylliosis Eosinophil granuloma Fertz granulomatosus 1. 2. 3. 4. 5. 6. Tubercolosis Candidiasis Macskakarmolsi betegsg

Coccidiomycosis Histoplasmosis Lepra A hypercalcaemia kezelse ltalnos Kalciumszegny trend, se-Ca-ot nvel gygyszerek elvonsa A calciuria nvelse Folyadk- s elektrolitptls, sdiurzis, loop-diuretikumok,dialysis A csontresorptio gtlsa Mobilizls,calcitonin,bisphosphontok,mithramycin, glucocorticoidok, prostaglandinszintzis-gtlk, gallium-nitrt A hypercalcaemit okoz betegsg kezelse ANYAGCSERE CSONTBETEGSGEK 2003 SE OK I. Belklinika

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