DEMOGRAPHIC DATA

 Name: Aling Dionisia

 Age: 63 years old
 Birthday: February 29, 1946
 Address: Buenavista, Santiago City
 Gender; Female
 Religion: Roman Catholic
 Date of Admission: June 16, 2009
 Chief Complaint: Nausea and vomiting, constipation, muscle
weakness, Flank pain, hematuria,
hypertension, pain during urination.

One week prior to admission, a 63-year-old woman with recurrent renal calculi
experienced nausea and vomiting, constipation, muscle weakness, joint and back pain
and hypertension. Three days prior to admission, patient was already having flank
pain, hematuria and pain during urination. And one day prior to admission, the above
symptoms worsen that is why the patient was rushed to Callang General Hospital by
her daughter to seek for medical management. On the day of admission, the patient
was seen and examined by the doctor with vital signs of BP=150/90; T=37.5˚C;
RR=21cpm ;PR=108bpm. The doctor ordered IV Fluid of PNSS 1L X 8 hours,
Urinalysis, Creatinine, ECG, Ultrasound and serum Calcium level, PTH level,
phosphate level for further management. The doctor also ordered Ketorolac 30mg q
6˚, Catapres now then Nifedipine after systolic becomes 130, Plasil 20mg PRN and
Dulcolax suppository now.
Question:
1. Based on the situation given, what type of hyperparathyroidism? Explain.
- Secondary hyperparathyroidism, because based on the history presented the
cause is not idiopathic but instead the renal failure that manifest on the patient is
the real cause of her disease since on the very first part of the history she had a
recurrent renal stones.

2. What is the reason why the pt. was given furosemide and not thiazide?
- The pt. was given furosemide because it helps the kidney to excrete excess
calcium in the body and not thiazide because thiazide is a potassium sparing
diuretic and thus, it also inhibit the excretion of calcium.
3. Why does the doctor ordered IVF of PNSS to the pt.?
- PNSS was ordered to the pt. because PNSS dilutes serum calcium and it increases
the urinary calcium excretion and thus, decrease the level of calcium in the blood.
4. Calcitonin and corticosteroid was also ordered to the pt., why?
- Calcitonin was ordered by the Dr. and at the same time a corticosteroid because
calcitonin decreases calcium serum and corticosteroid decreases bone turnover
and tubular reabsorption of calcium and results to a smaller calcium level in the
blood.
5. Why was ECG being ordered by the doctor?
- Parathyroid gland regulate calcium in the blood and calcium has a significant role in
muscle relaxation, activation, excitation and contractions of cardiac muscle.
6. Show the diagram how the patient manifest constipation?
Hyperparathyroidism
↓
↑ calcium in the blood
↓
↓ muscle tone of smooth muscle (GIT)
↓
↓ gastric motility
↓
Constipation

7. Show the diagram how the patient manifest muscle weakness and incoordination?
Hyperparathyroidism
↓
↑ calcium in the blood
↓
↑ blocking effect on cell membrane permeability
↓
↓ muscle tone of stratiated muscle
↓
Muscle weakness and coordination
8. One of the complication is peptic ulcer, discuss how this develop?
Hyperparathyroidism
 ↓
↑ calcium in the blood
↓
↑ secretion of acid and pepsin in the stomach
↓
Peptic ulcer
9. How does hyperparathyroidism lead to heart block?
Hyperparathyroidism
↓
↑ calcium in the blood
↓
↓ ↓
Formation of plaque in blood vessels Calcification of blood vessel and heart tissue
↓ ↓
↓
Heart block
10. How does polydipsia and polyuria occur to with hyperparathyroidism?
Hyperparathyroidism
↓
↑ calcium in the blood
↓
Disturbed renal tubular function
↓
Excessive urination
11. Why do we need to instruct the patient to increase fluid intake?
- Increasing fluid intake of the patient will help her to dilute serum calcium and urine
calcium excretion and also helps in kidney stone formation.
12. Why does immobility not advisable to patient with hyperparathyroidism?
- Patient with hyperparathyroidism is only encourage mobility because the more
pressure is being exerted by the bone the more it become strong, but if the patient is
immobilize, more bone is loss due to demineralization.
13. What is the diet indicate to our patient?
- The diet indicated for patient with this kind of disease is low in calcium.
14. Is the hyperparathyroid curable?
- Hyperparathyroidism is curable through surgery called parathyroidectomy, in which
the affected parathyroid gland is removed, whether it is half or all the 4 glands.and
after the surgery the patient can still live life the way she is before.