Hyperparathyroidism vs Hypoparathyroidism: Calcium Up vs Calcium Down
PTH is the calcium thermostat — too much pulls calcium out of bones and floods the blood; too little leaves calcium trapped and muscles fire on their own. Mixing up these two on the NCLEX means you'll pick calcium gluconate for a patient who already has dangerously high calcium, or restrict calcium in someone seizing from hypocalcemia.
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- ↑ PTH pulls Ca²⁺ from bone
- Primary: adenoma
- Secondary: CKD
- ↓ PTH causes hypocalcemia
- #1 cause: thyroid/neck surgery
- ★Bones, stones, groans, moans
- Muscle weakness, fatigue, hyporeflexia
- Polyuria, constipation
- ★Tetany
- Positive Trousseau & Chvostek
- Paresthesias, hyperreflexia
- Muscle cramps, laryngospasm
- ↑ Ca²⁺ (> 10.5), ↓ phosphorus
- ↑ PTH
- Shortened QT
- ↓ Ca²⁺ (< 8.5), ↑ phosphorus
- ↓ PTH
- Prolonged QT
- IV NS to flush out calcium
- Fall precautions
- Strain urine for stones
- Cardiac monitoring
- Monitor airway for laryngospasm
- Seizure precautions
- Keep IV calcium at bedside
- Cardiac monitoring
- Bisphosphonates / calcitonin
- Loop diuretic only if volume-overloaded
- Parathyroidectomy / adenoma removal
- ★IV calcium gluconate (acute), slow push
- Oral calcium + vitamin D (chronic)
- Increase fluids
- Stay mobile (weight-bearing)
- Avoid Ca²⁺/vit D supplements
- Report flank pain (stones)
- Lifelong calcium + vitamin D
- High-Ca, low-phosphorus diet
- Report tingling/numbness
- Heart block, arrest (severe ↑ Ca²⁺)
- Potentiates digoxin toxicity
- ★Laryngospasm (airway emergency)
- Tetany, seizures, prolonged-QT dysrhythmia
- Pathologic fractures
- Kidney stones
- Cataracts
- Basal ganglia calcification
Hyperparathyroidism
- ↑ PTH pulls Ca²⁺ from bone
- Primary: adenoma
- Secondary: CKD
Hypoparathyroidism
- ↓ PTH causes hypocalcemia
- #1 cause: thyroid/neck surgery
Hyperparathyroidism
- ★Bones, stones, groans, moans
- Muscle weakness, fatigue, hyporeflexia
- Polyuria, constipation
Hypoparathyroidism
- ★Tetany
- Positive Trousseau & Chvostek
- Paresthesias, hyperreflexia
- Muscle cramps, laryngospasm
Hyperparathyroidism
- ↑ Ca²⁺ (> 10.5), ↓ phosphorus
- ↑ PTH
- Shortened QT
Hypoparathyroidism
- ↓ Ca²⁺ (< 8.5), ↑ phosphorus
- ↓ PTH
- Prolonged QT
Hyperparathyroidism
- IV NS to flush out calcium
- Fall precautions
- Strain urine for stones
- Cardiac monitoring
Hypoparathyroidism
- Monitor airway for laryngospasm
- Seizure precautions
- Keep IV calcium at bedside
- Cardiac monitoring
Hyperparathyroidism
- Bisphosphonates / calcitonin
- Loop diuretic only if volume-overloaded
- Parathyroidectomy / adenoma removal
Hypoparathyroidism
- ★IV calcium gluconate (acute), slow push
- Oral calcium + vitamin D (chronic)
Hyperparathyroidism
- Increase fluids
- Stay mobile (weight-bearing)
- Avoid Ca²⁺/vit D supplements
- Report flank pain (stones)
Hypoparathyroidism
- Lifelong calcium + vitamin D
- High-Ca, low-phosphorus diet
- Report tingling/numbness
Hyperparathyroidism
- Heart block, arrest (severe ↑ Ca²⁺)
- Potentiates digoxin toxicity
Hypoparathyroidism
- ★Laryngospasm (airway emergency)
- Tetany, seizures, prolonged-QT dysrhythmia
Hyperparathyroidism
- Pathologic fractures
- Kidney stones
Hypoparathyroidism
- Cataracts
- Basal ganglia calcification
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High PTH = high calcium = bones break and stones form; low PTH = low calcium = muscles twitch and seize.
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