Cold Hands and Electrolyte Abnormality!

[K06100]

A 47-year-old woman comes to the emergency department with the chief complaint of “cold fingers.” She has had intermittent episodes of this condition for several years, but today the pain was unbearable. On review of systems she mentions chronic symptoms of reflux and progressive difficulty moving her fingers. When the physician examines her, he notes the appearance of her fingers (see image), and he also sees multiple telangiectasias on her skin and hard nodules on the extensor surfaces of her forearms. If the electrolyte abnormality associated with this patient’s most likely disease is found, what is the first step in correcting it?


Click image to enlarge

(A) 1 ampule of intravenous glucose
(B) Insulin and bicarbonate
(C) Intravenous calcium gluconate
(D) Intravenous normal saline
(E) Oral calcium channel blocker

[Hitman]

ans......C........

[K06100]

Originally Posted by Hitman

ans......C........

reason plzzzzz

[Anders]

I'm not understanding this Q clearly, but i think this is a CREST syndrome & the E would be the answer for Raynaud phenomenon

[XpaezX]

Its C because the C of CREST = CALCYNOSIS which would mean calcium deposition which would cause Hypocalcemia?

WTF WITH THESE QUESTIONS JESUS LORD CHRIST

[drsmart]

Originally Posted by XpaezX

Its C because the C of CREST = CALCYNOSIS which would mean calcium deposition which would cause Hypocalcemia?

WTF WITH THESE QUESTIONS JESUS LORD CHRIST

are u sure mate that doesnt seem correct

[absolutjag9]

calcium gluconate is used to treat hyperkalemia. ans E. calcinosis so u need to give nifedipine a CCB to lower Ca2+ levels.

[XpaezX]

Originally Posted by drsmart

are u sure mate that doesnt seem correct

Im sure about calcinosis, But i think it would be unreal for that much calcium deposition in the tissues to lower the serum calcium.

Calcium is not only used for Hyperkalemia, but also for severe forms of Hypocalcemia, however one doesnt use calcium gluconate, but calcium lactate which is better absorbed.

This question pretty much sucks ass because it is confusing, it is not asking about treatment for Raynaud's phenomenon/disease, but for the ELECTROLYTE abnormality found in the patient, I did a wild guess as im not sure about it actually.

And lastly im not your mate so you can take your little sarcastic smileys out of here

[Novobiocin]

Originally Posted by XpaezX

Its C because the C of CREST = CALCYNOSIS which would mean calcium deposition which would cause Hypocalcemia?

The only electrolyte abnormality I can think of is hyperkalemia due to ischemia of the fingers but it would be very difficult to cause the degree of hyperkalemia requiring treatment.
and since both B & C are used to treat Hyperkalemia they can't be the right answer, although C is the first step in treating hyperkalemia.
and A & D doesn't make any sense to me

Calcinosis: Evaluate serum calcium and phosphorus levels to exclude a metabolic disturbance; however, calcinosis resulting from limited scleroderma is not associated with calcium or phosphorus abnormalities.

[Anders]

Originally Posted by XpaezX

Its C because the C of CREST = CALCYNOSIS which would mean calcium deposition which would cause Hypocalcemia?

WTF WITH THESE QUESTIONS JESUS LORD CHRIST

U r right but i m not sure if calcinosis can be severe to cause hypocalcemia

[XpaezX]

Originally Posted by Novobiocin

(E) Oral calcium channel blocker

I know dude, thats why I put a question mark at the end of the sentence..

The question is badly written, asking for treatment of patient then yeah.. you pick E, but it asked about electrolyte abnormality thats the part that screwed me over

[Novobiocin]

Originally Posted by XpaezX

The question is badly written, asking for treatment of patient then yeah.. you pick E, but it asked about electrolyte abnormality thats the part that screwed me over

But the question is "If the electrolyte abnormality associated with this patient’s most likely disease is found, what is the first step in correcting it?"
So, C is my answer (on second thought).

I agree with you, this is a bad question--just splitting hair since there is no electrolyte abnormality associated with CREST syndrome.

[XpaezX]

Originally Posted by Novobiocin

But the question is "If the electrolyte abnormality associated with this patient’s most likely disease is found, what is the first step in correcting it?"
So, C is my answer (on second thought).

Thats why I put C XD, lol we both agreed on the same thing... but reached the conclusion in different ways.

[Novobiocin]

Originally Posted by XpaezX

Thats why I put C XD, lol we both agreed on the same thing... but reached the conclusion in different ways.

Yeah, but I have a feeling that answer will be D..............i really don't care what the answer is

[K06100]

The correct answer is D. This patient has CREST, which consists of Calcinosis, Raynaud’s phenomenon (presenting complaint), Esophageal dysmotility, Sclerodactyly, and Telangiectasias. CREST is a type of scleroderma that falls under the limited cutaneous systemic sclerosis designation. The prognosis is dependent on the extent of skin involvement. The initial treatment of hypercalcemia is always hydration, which can normalize the calcium level without further treatment. The empiric use of acid-reducing agents, particularly proton pump inhibitors, is generally recommended in order to revent the development of esophageal strictures. Calcium channel blockers are useful in decreasing the frequency of attacks of Raynaud’s phenomenon. The telangiectasias create a primarily cosmetic problem that can be improved with green oundation make-up or laser therapy for particularly large lesions.
Answer A is incorrect. Intravenous glucose ampules can be given for severe, symptomatic hypoglycemia. Also, in the case of hyperkalemia, glucose promotes insulin secretion, which subsequently promotes potassium uptake. Glucose will not have an effect on hypercalcemia
Answer B is incorrect. These are treatments for hyperkalemia. Insulin promotes cellular uptake of potassium, and bicarbonate increases the pH, which also shifts potassium into the cell.
Answer C is incorrect. This is a treatment for hyperkalemia. Calcium gluconate does not correct the hyperkalemia; however, it is the most expedient method of stabilizing the myocardium
Answer E is incorrect. Oral calcium channel blockers are used in the long-term management of Raynaud’s phenomenon to prevent recurrent attacks. Oral calcium channel blockers have no role in the acute treatment of hypercalcemia
in this scenario.