vnty
Forum Senior
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Posts: 87
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A 62-year-old man with a 20-year history of alcoholism is admitted to the hospital for treatment of alcoholic hepatitis. He appears disheveled and malnourished. He is 198 cm (6 ft 6 in) tall and weighs 70 kg (155 lb); BMI is 18 kg/m2. Examination shows jaundice and temporal wasting. Scattered rhonchi are heard throughout all lung fields. Cardiac examination shows no abnormalities. Bowel sounds are normal. The liver span is 16 cm. Sensation to pinprick and light touch is decreased over the feet. Deep tendon reflexes are decreased at the ankles. Laboratory studies show:
Hematocrit 33%
Platelet count 145,000/mm3
Serum
Na+ 131 mEq/L
Cl? 92 mEq/L
K+ 3.1 mEq/L
HCO3? 26 mEq/L
Mg2+ 0.8 mEq/L
Ca2+ 5.8 mg/dL
Urea nitrogen (BUN) 6 mg/dL
Creatinine 0.8 mg/dL
Test of the stool for occult blood is positive. Which of the following is the most likely mechanism of this patient's hypocalcemia?
A ) Chronic metabolic acidosis
B ) Hypomagnesemia
C ) Impaired hydroxylation of vitamin D
D ) Primary hyperparathyroidism
E ) Renal resistance to parathyroid hormone
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| drhyd
Forum Senior
Topics: 7
Posts: 82
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Well little bit confusing
according to me its hypomagnesemia
It decreases in malabsorption leading to ineffective or decreased PTH
Because of malabsorption there could be decreased vit d this is one more reason, but its not given in options.
it could not be renal because normal renal parameters.
Well confusion occurs when we think abt hydroxylation of vit d which occurs in liver and kidney and here thers problem with liver.i do not know how to rule out liver cause.
please anyone help me to rule out liver problem here.
Thank you
drhyd
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| frank100
Forum Guru
Topics: 48
Posts: 586
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agree, hypomagnesemia
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| Cedrick
Esculapio
Topics: 324
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label them
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| Cedrick
Esculapio
Topics: 324
Posts: 2,058
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let me see
patient is in for Alcoholic hepatitis
Between A and B ?
B.-hypomagnesemia is part of it
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| mazinger
Forum Guru
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Could anyone please explain how hypomagnesemia is related to alcoholic hepatitis?
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| drdiv
Forum Junior
Topics: 16
Posts: 63
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hypomagnesemia
i hav 2 reasons
mg is required for PTH secretion&
for the action of PTH on osteoclasts
please correct me if i am wrong
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| mazinger
Forum Guru
Topics: 46
Posts: 920
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Yes you are right about mg and pth...
but how is mg related to acute alcholic hepatitis?
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| mazinger
Forum Guru
Topics: 46
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drhyd said hypomagenesemia would be a consequence of malabsorption (and its true), but acute alcoholic hepatitis is not asociated with malabsorption nor chronic liver dzs..
Chronic pancreatitis is related to malabsorption, but I dont think they mention that in the vignette. Acute pancreatits is also related to Ca malabsorption and soap formation..
Liver dzs is related to deficit in the 25 hydroxilation of vit D, so this hypocalcemia probably is probably a consequence of an abnormal vit d metabolism..
Seems most reasonable to me...
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original mazinger z
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