doc_clotaire
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A. Hyperventilation ( She has respiratory alkalosis )
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| doyoudig
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a complication of Hyperventilation as the alkalotic state causes increased affinity for Free Ca to bind Albumin (as u can see albumin is low) henec Total Ca is normal but Free Inonized Ca is Decreased
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| robin082006
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| klimt
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agree with you all, A is the correct ans
but I wish they chose some disease other than Crohn's cuz at the same time it produces fat malabsorbtion and low vit D thus low Ca
I know here the low albumin and the respiratory alkalosis are the clues to hyperventilation
.... they try to confuse us on purpose 
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| doyoudig
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yes they do, do expect this also in the real exam, they'll give you a lot of garbage info and you'll have to sieve thru it
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| hanialkhadher
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Hyperventilation with Pco2 37 (normal 33-45)!!!!
CHECK THIS OUT FOUND IN MERCK MANUAL
Mg depletion usually results from inadequate intake plus impairment of renal or gut absorption. It has been described in association with prolonged parenteral feeding, usually in combination with loss of body fluids via gastric suction or diarrhea; lactation (increased requirement for Mg); and conditions of abnormal renal conservation of Mg, such as hypersecretion of aldosterone, ADH, or thyroid hormone; hypercalcemia; diabetic acidosis; and cisplatin or diuretic therapy.
Clinically significant Mg deficiency most commonly is associated with (1) malabsorption syndromes from all causes, in which elevated fecal Mg is probably related to the level of steatorrhea rather than to deficient bowel absorptive sites per se; (2) protein-calorie malnutrition (eg, kwashiorkor); (3) parathyroid disease, in which hypomagnesemia occurs after removal of a parathyroid tumor, especially if severe osteitis fibrosa is present (presumably, Mg is transferred to rapidly mineralizing bone, and Mg deficiency may account for the resistance of hypocalcemia to correction with vitamin D in occasional patients with hypoparathyroidism); (4) chronic alcoholism, in which hypomagnesemia probably is due to both inadequate intake and excessive renal excretion; and (5) chronic diarrhea.
Edited by hanialkhadher on 05/31/07 - 03:54 PM
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| fox
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I was wondering about the CO2 level too as it seems normal. The Ph is certainly alkaline
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| young_doc
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I go with hypomagnesemia... it explains the hypocalcemia, they hypokalemia, and it occurs frequently in patients on Parenteral nutrition.
The hypokalemia explains the alkalosis. They hypocalcemia explains the tetany.
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| sailing boat
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nopse its the hyperventilation young doc
ph inc, hence albumin leaves the h + ions and hence more calcium binds the albumin
and hence signs ie tetany, i think
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| young_doc
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The patient actually only has a relative hypocalcemia. There is a decrease in albumin of roughly 1 unit, and as a result, there SHOULD be a decrease in Ca of ~0.8...
I didn't see the pO2 87 the first time i read the Q.. that does make hyperventilation a likely answer. (though i don't like the normal CO2 level)
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| hanialkhadher
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Correction for serum calcium will be ~1.5mg +8.2=9.7
Do you think 0.03 increase in PH can couse tetany?
This case is perfect for Mg deficiency .
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| Akeen
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Thinks it's not hyperventilation cos it should cause a higher PO2, which is not very high in this vignette. Doesn't know the answer though.......
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| doc_clotaire
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so what s the answer Virgola 82?
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| webjeee
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what is the answer?
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| Akeen
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Answer please........!
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| virgola82
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I couldn't connect for few days... the right answer reported is HypoMg... Tough q
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| doc_clotaire
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Can you post the explanation please ?
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| virgola82
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This is the given explanation. I thougt it was hypervent too.
"Magnesium deficiency is common in malnourished patients and patients with large gastrointestinal fluid losses. The neuromuscular effects resemble those of calcium deficiency • namely, paresthesia, hyperreflexia, muscle spasm, and ultimately tetany. The cardiac effects are more like those of hypercalcemia. An electrocardiogram therefore provides a rapid means of differentiating between hypocalcemia and hypomagnesemia. Hypomagnesemia also causes potassium wasting by the kidney. Many hospital patients with refractory hypocalcemia will be found to be magnesium deficient. Often this deficiency becomes manifest during the response to parenteral nutrition when normal cellular ionic gradients are restored. A normal blood pH and arterial PCO2 rule out hyperventilation. The serum calcium in this patient is normal when adjusted for the low albumin. Hypomagnesemia causes functional hypoparathyroidism, which can lower serum calcium and thus result in a combined defect"
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| doc_clotaire
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Thanks!
Good question !
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| Akeen
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virgola82, thanks for the answer.
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| ashfaque
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Nice explanation . Thanks virgola 82
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