View Full Version : Int Med chat: Preventive and Emergency Medicine

04-08-2005, 08:43 PM
dua_frank has joined the chat.
[duttycup82] hi
[hehe] hi
[hehe] is anybody here
[priya24] Hii
[priya24] anyone
[andy1240] hi
[ebomkamp] hi
[ebomkamp] where is everoyne from?
[yeswhy] hi
[yeswhy] anyone here?
Now entering USMLE_Step_2 subroom.
dua_frank has joined subroom: USMLE_Step_2
[megs] hi dua
[megs] how are you??
[dua_frank] hi megs
[dua_frank] i;m okay
[dua_frank] you?
[megs] fine
[dua_frank] how are you preparing?
[megs] ok dua...i have taken uw for 1 month so doing about 70 q each day
[dua_frank] how are you scoring?
[megs] just bet n 55 to 60
[dua_frank] thats good megs
[megs] sometimes 52 too...
[dua_frank] do you know its correlation to real exam score/
[megs] no...but they say bet n 50 to 60 is compitative score
[dua_frank] yeah
[megs] i guess compitative means..passing lol
[dua_frank] no it means its really good
[megs] what about u???
[dua_frank] i didn't go UW yet
[dua_frank] i think i will take it next month
[megs] ohh..ok
[dua_frank] scoring only 60-65% on kap q bank though
[dua_frank] don't know how to inc score
[megs] just we have to work on the weak area
[dua_frank] yeah
[dua_frank] all areas are weak :(
[megs] thats how we can do...cardio psychi...are weakest of mine
[megs] and endocrino too
[dua_frank] hemato for me
[megs] and they ask lot about cardio
[dua_frank] and obgyn too
[dua_frank] endo me too
[megs] lets discuss as much as we can on chat
[dua_frank] very volatile
[megs] yes
[dua_frank] yes
[dua_frank] shall we start?
[dua_frank] its late
[megs] yes
[dua_frank] rx of hyperkalemia
[megs] insulin. glucose drip.bicarbonate, calcium gluconate
[megs] calcium gluconate most imp
[dua_frank] right thats the first to give
[dua_frank] then bicarb and then rest
[dua_frank] resin is?
[megs] in case of eck changes
[megs] ekg
[dua_frank] kayexalate, you told me this one
[megs] resin...binds with excess k
[dua_frank] yes
[megs] yes i remember dua lol
[dua_frank] what electrolyte abnormality does licorice cause?
[megs] hyperkalemia
[megs] whats the topic today dua???
[dua_frank] hypokalemia
[dua_frank] its emergency med megs
[dua_frank] but theres so much in emergency med that i thought i can take up anything randomly
[dua_frank] as long as its emergency
[megs] ok i thought electrolytes..as u started with that
[megs] ok fine
[megs] what is treatment of cardiac asystole??
[dua_frank] atropine
[dua_frank] epi and then PM
[megs] atropine???
[megs] thats for heart block i guess
[dua_frank] yes
[megs] first u have to give epi
[dua_frank] ok
[megs] and then in atropine for asystole
[dua_frank] rx of RTA I?
[dua_frank] ok
[megs] i.v saline ns??
[dua_frank] oral bicarb
[dua_frank] or aldosterone
[megs] what happens in RTA 1??
[dua_frank] can't excrete acid
[dua_frank] so the urine is alkaline
[dua_frank] happens at DT
[dua_frank] diagnosis by giving acid load
[megs] then why to give aldesterone??
[dua_frank] normally acid should appear in urine
[dua_frank] but in RTA I it doesnt
[dua_frank] Ph still remains high
[dua_frank] to correct hyperkalemia
[dua_frank] they have hyporenin and hypoaldo
[megs] ok got it dua
[megs] can u tell me difference in all types of acidosis??
[megs] how to distinguish them...charecterwise
[lanny] hi guys
[megs] i mean renal tubular acidosis
[dua_frank] will try to
[dua_frank] hi lanny
[megs] hi lanny
[dua_frank] in RTA II what happens is that the PCT cannot absorb hco3
[megs] ok
[dua_frank] so initial urine is basic but as its level goes down in the body, the kidneys start excreting acid to compensate
[dua_frank] then the urine becomes acidic
[dua_frank] so in RTA II urine is acidic
[dua_frank] RTA I urine is basic
[dua_frank] both have hypokalemia
[megs] ok
[dua_frank] high serum bicarb level in RTA II
[dua_frank] high serum acid in RTA I
[megs] thanx dua
[dua_frank] welcome
[dua_frank] its hard to remember
[megs] what is transcuteneous spacing???
[dua_frank] they put the pm on the skin
[dua_frank] used for bradycardias
[lanny] dua so how come serum bicarb is high in RTA2? is it because of the excess loss of acid relativety??
[dua_frank] figuring it out lanny :(
[megs] rta 2 is fanconis like
[blacktown] hi
[dua_frank] yes
[dua_frank] explain fanconi :(
[dua_frank] i forgot it :(
[dua_frank] hi blacktown
[megs] fanoconi px tubular defect
[megs] looses glucose,amino acid phosphate
[dua_frank] oh yeah
[lanny] right megs just need to clarify HCO3 level in serum
[blacktown] impaired glucose a.a.s hco3 and phosphate absorption in prox tubules
[blacktown] glucosuria-hyperphosphaturia-hyphophosphatemia and aminoaciduria
[megs] but didnt get about bicarbonate lanny
[dua_frank] continue
[dua_frank] i'll read up and let you know
[lanny] bicarb is in low range in type 2
[megs] bicarbonate has to be low
[dua_frank] did i say high?
[dua_frank] no no its low
[lanny] yes megs i thought so but dua will clear it up
[dua_frank] 18-20
[dua_frank] i'm wondering what the pathology is
[megs] how do we diagnose RTA 1???
[dua_frank] sorry i said that
[dua_frank] high acid in RTA I
[dua_frank] and low bicarb in RTA II
[dua_frank] acid load test
[lanny] on the low range cause remember when the k senses its getting low it then starts to secrete acid to compensaye so its not very low but on the low end of normal
[lanny] ok dua thanks good explanation it reinforces it
[dua_frank] thanks for clearing it too
[dua_frank] so RTA I people can't excrete acids
[dua_frank] RTA II people can't reaborb bicarb
[blacktown] what kind of acids?
[lanny] acid secretion is their problem
[dua_frank] yes
[blacktown] in RTA any respiratory compensation?
[dua_frank] yeah
[lanny] trhere should be
[dua_frank] they would be if the electrolytes are compensated too much
[lanny] so long as the boody isok to maintain equi
[blacktown] me too megs
[lanny] in what megs?
[megs] rta lanny
[dua_frank] you asked respiratory
[lanny] what are you saying megs??
[blacktown] yes i asked resp. but megs added renal
[blacktown] that s ok
[dua_frank] if there is too much base being excreted in RTA II
[dua_frank] there will be eventually a compensatory loss of acid
[dua_frank] this is why later you do see acidic urine instead of basic urine
[lanny] oh megs you mean type1
[megs] i am confused ..
[lanny] in type 1 no compens urine PH remains high
[dua_frank] yeah i would agree with what megs said regarding RTA I
[lanny] what did megs say dua
[dua_frank] she said there is no renal compensation
[dua_frank] i am adding that yes tehre is no renal compensation in rta i
[blacktown] i think i confused you all as i added compensation mechanisms
[lanny] yes i agree but she did not clarify it i just figured it out
[dua_frank] well its good to know blacktown
[lanny] thats true there is no renal compens unlike 2
[dua_frank] rx for rta ii?
[megs] i said there is no respiratory compensation for renal tubular acidosis...but there might be renal compensation
[lanny] potassium supplements
[dua_frank] why wouldn't there be resp compensation megs?
[dua_frank] its the first to kick in
[dua_frank] renal happens after days
[lanny] sure dua
[dua_frank] mild volume depletion lanny
[lanny] i agree with you
[dua_frank] says if you restrict water, it makes the urine bicarbs higher causing a type on contraction alkalosis
[dua_frank] making the PCT reabsorb bicarb
[dua_frank] weird
[dua_frank] you would give pot in all RTAs lanny
[dua_frank] all would have hypokalemia
[lanny] yes 1 and2
[lanny] type 4 is no
[dua_frank] oops yes
[dua_frank] you're right
[dua_frank] sorry
[dua_frank] not in 4
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[lanny] you give furowemide or kayexelate
[lanny] fludricortisone tooo
[dua_frank] rx of rta 4?
[dua_frank] right
[dua_frank] this is hard to remember
[lanny] oh thans to this chat i read it a few times and have u stood it better than before
[dua_frank] great lanny
[dua_frank] both rtas aim at bicarb incr
[dua_frank] in blood
[dua_frank] one by givign oral bicarb
[dua_frank] the other by restricting fluid and causing bicarb reabsop in pct
blacktown has left the chat.
[dua_frank] these two are probably the only types of acidosis where you will find hypokalimia instead of hyper
[dua_frank] tell me if you know more please
[lanny] no dua dont
[dua_frank] don't what lanny?
[dua_frank] oh you don't know more, okay
[lanny] yep
[dua_frank] tell me the primary disturbance
[dua_frank] ph low, h+ high, bicarb low
[lanny] met acidosis
[dua_frank] pco2 low
[dua_frank] yes
[dua_frank] how did you guess without pco2 value lanny
[lanny] cause bicarb is low
[dua_frank] right
[dua_frank] if the picture was high, low and low?
[dua_frank] ph high, h+ low pco2 low and hco3 low
[lanny] need co2 then
[lanny] resp alkalosis
[dua_frank] right
[dua_frank] pco and hco3 always run in the same direction
[dua_frank] look at the ph
[dua_frank] and then h+
[lanny] whats a mixed d.o.?
[megs] in mixed...eitther PH WILL be normal or extremes of value
[dua_frank] mixed pco and hco3 run oppositive
[dua_frank] one would he high and the other low
[lanny] ok guys thanks
[megs] how do we treat ventricular fibrillation??
[dua_frank] defib
[dua_frank] cardiovert that is
[lanny] CPR
[megs] yes cpr first
[lanny] then meds
[dua_frank] why is that important
[dua_frank] to say cpr
[lanny] usu epineph is given first
[dua_frank] you didn't say where the patient was
[megs] what will u do if defibrillater not avialable???
[dua_frank] suppose v fib happened in icu
[dua_frank] why will i do cpr? i would do defib first
[lanny] while calling for help first
[dua_frank] you didn't say where the pateint was megs
[lanny] then start by doing CPR
[megs] sorry dua
[lanny] defillibrate if in hospital
[dua_frank] i think we should look at the whole scenario
[lanny] 200-300 joules
[dua_frank] they might give a clue saying hospital setting, then we better answer defib
[megs] yes dua u are right
[dua_frank] what stones are formed in acid urine and what in alkaline?
[lanny] i found a q they ask doctor on the way home from hospital
[lanny] met a man on the street collapse in front of him
[dua_frank] call 911
[dua_frank] yes
[lanny] right dua
[dua_frank] i want to know about acid stones guys
[dua_frank] calcium oxalate and uric acid in acidic urine i think
[dua_frank] thats why we alkalinze urine
[dua_frank] and stuvite and cysteine stones in alkaline urine
[dua_frank] correct me if i am wrong please
[megs] u are right dua
[lanny] calsium struvte are acid
[lanny] uric acid
[dua_frank] stuvite stones are made of al hydroxy ptite stones
[dua_frank] alkaline right?
[megs] dua cq about ca oxalate stone
[dua_frank] will do and let you know megs
[lanny] yes dua
[megs] for oxalate we..acidify urine
[lanny] cal oxalate are alkaline stones
[dua_frank] thanks
[megs] yes lanny
[dua_frank] so which are the acidic stones?
[dua_frank] uric acid and ?
[lanny] i think cystine
[dua_frank] yeah
[dua_frank] extra renal manifestions of something, hepatic cysts, ht, colonic diverticula, intracranial aneurym
[dua_frank] whats that something?
[lanny] cant figure dua
[dua_frank] APDK
[dua_frank] said extra renal
[dua_frank] APKD i mean
[dua_frank] what does it cause in the heart?
[lanny] MVP
[dua_frank] right
[dua_frank] black hypertensives, first line drug rx?
[lanny] diuretics
[dua_frank] yes or ccbs
[dua_frank] what drugs are less effective in them?
[lanny] ACE
[dua_frank] yes
[lanny] which drug dec mortality in HTN
[dua_frank] bbs
[lanny] right
[dua_frank] and ace inhibs
[dua_frank] no no
[dua_frank] only bbs
[dua_frank] ace i for nephropathy
[lanny] yes only b blockers dua
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[lanny] shich drug is better in whites??
[dua_frank] any?
[dua_frank] bbs?
[lanny] ACE
[dua_frank] oh :)
[lanny] ACE is for white and young
[lanny] CCBL is for black and old
[dua_frank] ok
[dua_frank] what drug in emergency ?
[dua_frank] hypertension
[lanny] sodium nitroprusside
[dua_frank] yes
[lanny] IV diazoxide
[dua_frank] whats the prefered drug in CAD patients with emergency?
[lanny] subling nitro?
[dua_frank] NTG
[dua_frank] yes
[dua_frank] no IV
[dua_frank] SL doesn't work for emergency
[dua_frank] you give an infusion
[lanny] oh ok dua
[dua_frank] best test for Renal stenosis?
[lanny] suregery
[lanny] oh sorry
[lanny] US
[dua_frank] captopril renogram
[dua_frank] usg can be intial test
[dua_frank] when do you give ace inhib in rs?
[lanny] ok agree US is initial
[lanny] unilateral
[dua_frank] when surgery or angioplasty fails
[dua_frank] main stay is always stent or surgery
[dua_frank] when do you not give ace in in RS?
[lanny] bilateral
[dua_frank] right and why?
[lanny] can vasoconstrict sending BP sky high
[dua_frank] you mean AT II rises?
[dua_frank] i thought renal failure
[dua_frank] leading to death
[dua_frank] and low renin
[dua_frank] sudden drop in renin right?
[lanny] yes its renal failure
[dua_frank] how does it cause that lanny?
[dua_frank] i think what happens is when the renin falls suddenly and body becomes hypotensive
[lanny] ACE is inhibited, causing renein to be low k cannot vasoconstrict
[dua_frank] the kidneys renal arteries suddenly constrict more
[dua_frank] in compensation
[dua_frank] causing RF
[dua_frank] but i maybe wrong
[lanny] right i have to remember from step 1
[lanny] lemme think dua
[lanny] will have to chk dua
[dua_frank] ok
[dua_frank] how will you check primary hyperaldo from secondary aldo?
[lanny] oh sorry i was looking for my step 1 book
[dua_frank] no problem
[lanny] ok primary is no edema
[dua_frank] yes
[dua_frank] what else
[lanny] also inc BP
[dua_frank] right
[dua_frank] and dec renin levels
[lanny] yes
[dua_frank] when do you do acth stimulation test?
[lanny] conns dz is primary right
[dua_frank] yes right
[lanny] in addisons?
[dua_frank] to differentiate between primary and secondary adrenal insufficiency
[dua_frank] when you givt acth the cortisol levels increase gradually
[dua_frank] in primary
[lanny] in primary
[dua_frank] no wait
[dua_frank] gradual cortisol rise is normal response
[dua_frank] sudden high increase is due to seconday adrenal insufficiency
[dua_frank] meaning the adrenals were acth starved
[dua_frank] so had become hypersensitive
[lanny] and shrink
[dua_frank] primary would show no effect i think
[dua_frank] yes shrink too
[dua_frank] big in CAH
[dua_frank] what will overnight dexa test differentiate?
[lanny] normal or abnormal gland
[dua_frank] right
[lanny] cause signs of cushing can be by diab cushing adiposity etc
[dua_frank] what will 24 hrs cortisol levels tell?
[dua_frank] yes
[dua_frank] urine cortisol that is
[lanny] high urine cort shows normal gland
[lanny] cause dexa is a potent cortisol
[dua_frank] no it differentiates cushings syndrome from other causes like stress and obsity
[dua_frank] no urine corisols in urine in stress
[dua_frank] then do a high dose dexa test
[dua_frank] normal levels will show that it was primary or cushing disease from pit
[lanny] ok dua hear it from my standpoint.give me a minute
[dua_frank] high levels say it is either from lung or from adrenals themselves, then measure acth levels in this case. high levels of acth from lung ca secreting acth and low in adrenal tumours secreting cortisol
[dua_frank] oh ok, sure lanny
[lanny] dexa is itself a potent cortisol so given at noght to tell cause of cushings
[lanny] desa stim CRH ACTH in turn cortisol inc in am
[lanny] in normal gland
[lanny] so this tells you the pit is ok the gland is ok
[lanny] so the cause of cushin features is obesity diab etc
[dua_frank] dexa inhibits pit acth release lanny
[lanny] am i right so far
[dua_frank] so cortisol is low normally
[dua_frank] if it is high, it points to cushings synd
[dua_frank] this is by low dose dex overnight test
[lanny] youre right i was just dtarting to diff any cause of cushing from other poss causes
[dua_frank] ok
[lanny] but here dua you missed high dose
[dua_frank] after this you measure urine cortisol levels
[dua_frank] then you do high dexa test
[lanny] it is high dose that inhib pit release
[dua_frank] to differentiaet curhisngs disease from synd
[dua_frank] right
[lanny] right
[dua_frank] ok great
[dua_frank] we got it all together
[lanny] right
[dua_frank] then we measure acth levels in cushings syndrome to detect the causes, if lung or adrenal
[lanny] right
[dua_frank] i guess this was the tough part in endocrine
[dua_frank] about adrenals
[lanny] yep this is it just know it confusing
[dua_frank] yes
[dua_frank] what antihypertensive is used in eclampsia?
[lanny] my 2 wk point so far are endo and renal
[lanny] hydralazine
[dua_frank] me too
[dua_frank] yes good
[lanny] i am on OB now dua lol
[lanny] thats why i remeber
[dua_frank] ;p; pl
[dua_frank] lol
[lanny] this is a marathon dua you put it so right
[dua_frank] i know
[dua_frank] nobody no matter how intelligent can pass this exam in a month
[lanny] what are you talkin a month i knoow people in years even have giving up
[dua_frank] its tough
[dua_frank] sanz studied for two months
[dua_frank] i don't know how she did it
[dua_frank] and still got a 99
[lanny] everything i involved knowledge luck how you feel etc..
[lanny] yes i credit her
[dua_frank] ive been studying for two months now and i don't even feel close to giving the exam yet
[lanny] ive been off and on for nearly a year now...lol
[dua_frank] lol
[dua_frank] you were working too
[dua_frank] so i can understand that
[lanny] yes just barely got some time off
[dua_frank] how will you rx dawns and smoyigi ?
[lanny] somogyi is inc nightins
[lanny] inc night time INS
[dua_frank] down inc
[dua_frank] smogyi dec
[lanny] in dawn you inc night time ins
[dua_frank] yes
[dua_frank] coz its true hyperglycemia
[lanny] yes
[lanny] somogyi is rebound hyper
[dua_frank] yes
[dua_frank] that is the crazy one
[dua_frank] happening coz you gave too much night ins
[lanny] so dec night time ins to prvt early morn hypo
[dua_frank] so dec it
[lanny] this thing is not diff but boy need time to think.....
[dua_frank] how will you diff primary hyperparathyroidism from secondary hyperparathyroidism?
[dua_frank] yes i know
[lanny] PTH levels
[dua_frank] both will have raised pth levels
[dua_frank] its the calcium levels
[dua_frank] high calcium in primary
[dua_frank] low or near normal in secondary
[lanny] no dua in primary PTH is high
[dua_frank] secondary is due to vit d def usually or low calcium levels
[dua_frank] which causes high pth in response
[lanny] dont think so dua
[dua_frank] take a minute and think lanny
[dua_frank] or open your notes
[dua_frank] its better to clear it right now
[dua_frank] primary hyperparathyroidism happens due to adenoma in the parathyroid gland right?
[lanny] right
Yousef has left the chat.
[dua_frank] yeah so here you will see high calcium
[dua_frank] and low po4
[dua_frank] right?
[lanny] right
[dua_frank] now secondary rise in pth is due to something that trigers its release
Yousef has left the chat.
[dua_frank] that somethign is low calcium in the blood
[dua_frank] usually in renal failure with vit d def
[lanny] oh i see now
[dua_frank] pth rises to inc calcium levels in the blood but only barely brings it to normal
[lanny] i was talking about hypercalcemia
[lanny] as a cause
[dua_frank] yeah thats different
[dua_frank] we're talking about hyperparathyroidism
[dua_frank] pth rise only
[lanny] ok my mistake youre right
[dua_frank] its rather confusing adn easily forgetable :(
[dua_frank] i'm trying to teach myself too along with telling you here
[dua_frank] sometimes telling is a good way of retaining things too
[lanny] yes but this explanation will be for wecondary right?
[dua_frank] yes right
[lanny] oh yes i do that too.. i teash all my tables and chairs in my house...lol
[dua_frank] lol
[lanny] i teach
[dua_frank] too bad chairs and tables don't ask qs back :P
[lanny] lol lol lol
[dua_frank] its more beneficial with real people who tell you that you are wrong when you make a mistake
[dua_frank] lol
[lanny] when my fiance is tired of listening to me.....
[lanny] i turn to talk to my furniture,,
[dua_frank] lol
[dua_frank] its really hard for those who live with us, poor things
[lanny] tell me about it.....
[lanny] even my poor mum is having sleepless nights
[dua_frank] which diuretic can you use in hypercalcemia?
[dua_frank] which one is contraindicated
[dua_frank] lol
[lanny] ok dua.. carefull here lol
[lanny] thiazides cause hypercalcemia
[dua_frank] good
[lanny] loop cause hypocal
[dua_frank] great
[dua_frank] i must say you are totally prepared lanny
[lanny] these two are another confuslin bunch
[dua_frank] things come back so easily to you now, don't they?
[lanny] dua ive been reading for a while now i ned to be...
[lanny] thats why i was in this chat since day 1
[dua_frank] me too
[dua_frank] i rarely miss here
[lanny] i found it very helpful
[dua_frank] good to get concepts together
[lanny] i think i messed 3 days since we started in mid January
[lanny] yes...
[lanny] ok dua back to kaplan q bank
[dua_frank] ok
[lanny] wanna do a last set of 50 before i go to bed
[lanny] still cant get over 70
[dua_frank] you want moer?
[dua_frank] greedy greedy
[lanny] y day i got 80 and sas jumoing up and down
[dua_frank] wow
[dua_frank] lol
[dua_frank] you'er going great lanny, don't stop the pace, you're in for a 99 for sure
[dua_frank] last q before we go
[dua_frank] tertiary hyperparathyroidism
[lanny] well whatever 70 gives me in ther real test i will gladly take
[dua_frank] how will you differentiate this from primary?
[dua_frank] this happens in the backdrop of a preexisting secondary hyperparathyroidism
[dua_frank] meaning there will be low ca levels here too for a long time
[lanny] oh sorry the phone rang dua
[dua_frank] and then PTs will start acting autonomously and keep releasing pth
[lanny] whats the q?
[lanny] oh ok dua right
[dua_frank] if you gave calcium, pth levels would come down in secondary
[dua_frank] but they will not in primary and secondary
[lanny] yes
[dua_frank] agreed?
[dua_frank] ok great
[dua_frank] thats it then lanny
[dua_frank] it was a nice day
[dua_frank] see you tomorrow
[lanny] no dua
[dua_frank] no?
[dua_frank] ok
[dua_frank] please explain
[lanny] ok sorry i thought youre talking about tertiary
[dua_frank] last point lanny
[dua_frank] i have a q
[dua_frank] in secondary hyperparathyroidism, where we see compensatory rise in pth levels, we know there is hypocalcemia already, what happens to po4 levels here?
[lanny] low
[lanny] cause its a secondary hyperthy
[dua_frank] what does vit d do to po4 level in blood?
[dua_frank] dec or inc?
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[lanny] vit D inc po4
[dua_frank] ok low then
[dua_frank] and pth does the same right?
[lanny] vit D cause inc in po4
[lanny] and inc in cal
[dua_frank] do we have a condition where we see high vit d as well as high pth in blood as compensation?
[dua_frank] yes right
[dua_frank] osteoporosis right?
[dua_frank] anything that causes loss of ca
[lanny] could you explain?
[dua_frank] where both vit d syns and pth production will inc
[lanny] oh yes possible
[dua_frank] ok so here, who will affect po4 levels
[dua_frank] vit d or pth?
[dua_frank] will the patient have high po4 due to vit d or low due to pth?
[lanny] pth will
[dua_frank] kaplan says vit d
[lanny] kinda confused dua put it another way
[dua_frank] pt will have high p04
[dua_frank] i know its confusing
[dua_frank] think of a condition causing hypocalcemia
[dua_frank] any condition
[dua_frank] which can trigger vit d production and pth
[dua_frank] both to conserve calcium
[dua_frank] i was just thinking how this would affect po4 levels
[lanny] both will
[dua_frank] since we know pth inc ca in the blood and dec po4
[dua_frank] and vit d will inc both
[dua_frank] right?
[dua_frank] which one predominates for po4 levels?
[lanny] right
[lanny] PTH
[dua_frank] i would think so too
[lanny] dua remember......
[lanny] its the low cal that secr inc PTH
[dua_frank] yes
[lanny] that in turn stim intest to abs inc vit D
[dua_frank] right
[lanny] vit D causes inc cal and po4
[dua_frank] right
[lanny] thru kinney and intestine
[lanny] so vit D cause ind cal and po4
[dua_frank] and pth directly affects kidneys and intestines too lanny
[dua_frank] causing inc ca abs and dec po4 resorption
[lanny] prim and sec PTH caouses low po4 and high ca
[lanny] yes
[lanny] PTH allso stim K to prod inc reabs of cal
[dua_frank] so both are acting differently on po4s
[dua_frank] one makes it high the other low
[lanny] what you mean both?
[lanny] prim and sec have low po4
[lanny] vit d has high po4
[lanny] one point though PTH does reabs of calcium in intestine thru vit D
[dua_frank] ok let me type something for you
[dua_frank] says here
[dua_frank] low calcium with high phosphorus seen in renal failure with massive tissue destruction, hypoparathyroidism and pseudohypoparathyroidism
[dua_frank] agreed?
[dua_frank] no pth, no calcium high phos
[lanny] but it is a secondary PTH so po4 should be low
[dua_frank] no this is the case with hypoparathy
[dua_frank] which is why calcium is low
[dua_frank] like after parathyroid surgery
[lanny] h dua when did you start talikng about hypo?
[dua_frank] hehe
[dua_frank] i was talking about po4
[lanny] ok i got it now
[dua_frank] and how vit d and pth affect it differently
[lanny] sorry i didnt read the above you typed
[dua_frank] you are right with what you said lanny
[dua_frank] everything
[dua_frank] in vit d def you will see low calcum and low phos
[dua_frank] this is the secondary hyperparathyroidism picture
[dua_frank] phew
Please rephrase your last message.
[lanny] yes
[dua_frank] forget what i said about osteoporosis please
[dua_frank] i was confused there
[lanny] ok dua
[dua_frank] osteomalacia itself results due to vit d def
[lanny] yes
[dua_frank] i got confused there
[lanny] ok dua....
[dua_frank] so shall we call it a day then?
[lanny] lets cont tomorrow
[dua_frank] ok sure
[dua_frank] take care and good night
[lanny] good night and thanks for today
[lanny] i will you too...
[dua_frank] welcome and thanks to you too
[dua_frank] bye
[lanny] cheers!!
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