sarcoid : when to give steroids| saline for hypercalcemia. - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-21-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default sarcoid : when to give steroids| saline for hypercalcemia.

best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (08-22-2012)



  #2  
Old 08-21-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Quote:
Originally Posted by tyagee View Post
best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
for asymptomatic hyperCAl in sarcoid use steroids not saline .......thats what i read in uw i guess .......
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (08-22-2012), tyagee (08-21-2012)
  #3  
Old 08-21-2012
Anders's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 289
Threads: 7
Thanked 129 Times in 102 Posts
Reputation: 139
Default

Quote:
Originally Posted by tyagee View Post
best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.
Well, from my understanding asyptomatic sarcoid pt. generally need no treatment but if the case is syptomatic for hypercalcemia u ll treat it with I.V. saline and prednisone at the same time.
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (08-22-2012), shyangel18 (08-21-2012)
 
  #4  
Old 08-21-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by Anders View Post
Well, from my understanding asyptomatic sarcoid pt. generally need no treatment but if the case is syptomatic for hypercalcemia u ll treat it with I.V. saline and prednisone at the same time.
can we have any source ? i cant find this info
Reply With Quote Quick reply to this message
  #5  
Old 08-22-2012
Anders's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 289
Threads: 7
Thanked 129 Times in 102 Posts
Reputation: 139
Default

Quote:
Originally Posted by tyagee View Post
can we have any source ? i cant find this info

My source is UW for step 3
Reply With Quote Quick reply to this message
  #6  
Old 08-22-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Default

Quote:
Originally Posted by tyagee View Post
best initial treatment for symptomatic hypercalcemia is IV saline. if in q,sarcoid patient is hypercalcemic and asymptomatic ....when to start saline ? is it more than 12 [moderate hypercalcemia] .. and when steroids ? cant find any good source to refer to.

Calcium metabolism is dysregulated in active sarcoidosis. This may result in hypercalciuria, hypercalcemia, and nephrolithiasis that may lead to renal insufficiency.28 The primary abnormality in calcium metabolism relates to an increase 1-α hydroxylase activity in sarcoid alveolar macrophages that converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D, the active form of the vitamin.29

The treatment of hypercalcemia includes the following:
(1) maintenance of an expanded intravascular volume;
(2) reduction of oral calcium supplements, dietary calcium, and vitamin D;
(3) reduction of the inappropriate production of 1,25-dihydroxyvitamin D by sarcoid macrophages and granulomas; and
(4) reduction of 1,25-dihydroxyvitamin D–induced intestinal calcium absorption and bone resorption.

Mild hypercalcemia can be treated initially with the first two approaches:
increased fluid intake and restriction of dietary calcium. The patient should be advised to curtail intake of major sources of dietary calcium and vitamin D, avoid sunlight, and drink a large amount of fluids.

If the serum calcium level is >11 mg/dL, the serum creatinine is elevated, or the patient has nephrolithiasis, pharmacotherapy is usually required.


The drugs of choice are corticosteroids at an initial daily dose of 20 to 40 mg/d of prednisone equivalent. Corticosteroids should be rapidly effective, and failure of the serum calcium to normalize on this regimen in 2 weeks should alert the clinician to an alternate or coexisting disorder, such as hyperparathyroidism, lymphoma, carcinoma, or myeloma. Once the calcium disorder is brought under control, the corticosteroid dose can be lowered over the following 4 to 6 weeks.30 If the patient develops intolerable corticosteroid side effects or fails to respond, chloroquine,31 hydroxychloroquine,32 and ketoconazole33 have been used successfully.

Ref ACCP

http://www.chestnet.org/accp/pccsu/t...dosis?page=0,3
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (08-24-2012), tyagee (08-22-2012)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Blood Transfusion: To give or not to give! Ayshee USMLE Step 2 CK Forum 7 03-30-2012 08:19 PM
Treating excessive steroids with steroids! kenlee USMLE Step 1 Forum 4 03-09-2012 07:33 AM
When to give saline and half strenght saline! kemoo USMLE Step 2 CK Forum 0 06-06-2011 09:49 AM
infusion of isotonic saline ?? kemoo USMLE Step 1 Forum 3 01-24-2011 02:18 AM
When to give IV fluids and when to give blood for a bleeding pregnant patient Katharina USMLE Step 2 CK Forum 3 06-11-2010 04:35 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)