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Old 10-18-2011
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Question Metastatic calcifications!

A 69-year-old man comes to clinic complaining of chronic pain in his joints. He is well known to the clinic, where he is followed for hypertension, diabetes, and renal failure requiring hemodialysis three times per week. While he is compliant with dialysis, he often fails to take his medications, and tends to pick and choose which pills he takes. During the patient’s physical examination, multiple small, firm subcutaneous nodules are noted on his forearms, chest, and back. Additionally, radiographs taken as part of the patient’s workup reveal diffuse calcifications in the arteries, joints, and soft tissue. The pattern is described in the radiologist’s report as a “metastatic calcification” pattern. Which of the following is the most likely underlying electrolyte abnormality?

A. Hyperkalemia
B. Hyperphosphatemia
C. Hypocalcemia
D. Hypokalemia
E. Hypophosphatemi
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Old 10-18-2011
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i m with b
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Old 10-19-2011
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Good question. I went looking for hypercalcemia but couldnt find it lol

Answer is B.

In metastatic calcification, calcium-phosphate is what is deposited in soft tissues so expect both calcium and phosphate to be high

Correct me if I'm wrong
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B. Hyperphosphatemia
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Old 10-19-2011
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Correct Answer Answer

The correct answer is B. Dialysis patients need to take phosphate binders. Phosphate is normally cleared by the kidney, but is poorly filtered by hemodialysis. Long-standing hyperphosphatemia can result in calcium-phosphate aggregations, which diffusely precipitate, a process known as metastatic calcification. Further, such patients are at risk for significant renal osteodystrophy. The homeostatic response to the elevated PTH levels and calcium-phosphate aggregations is to release more calcium from bone. As such, calcium levels are usually normal, not low (choice C). As the kidney no longer clears phosphate, and dialysis does not remove the phosphate, hypophosphatemia (choice E) is unlikely.
Patients who are compliant with dialysis usually do not suffer hyperkalemia (choice A). Non-compliant dialysis patients with muscle cramps often suffer hyperkalemia. As renal clearance of potassium is severely limited in renal failure, the alternative situation, hypokalemia (choice D), is unlikely in renal failure patients.
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Tags
Electrolytes-, Endocrinology-, Internal-Medicine-, Nephrology-, Rheumatology-, Step-2-Questions

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