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Day 1 Pathophysiology of secondary hyperparathyroidism (secondary to CKD)   Calcium and phosphorous homeostasis is tightly regulated between bone, the kidney, and the parathyroid gland. Key modulators of calcium and phosphorous include FGF-23, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone. FGF-23 is released from bone due to increasing serum phosphorus levels and acts in the kidney to increase phosphorous excretion and decrease 1 alpha hydroxylation of 25-hydroxyvitamin D. FGF-23, along with serum phosphorous, also decreases parathyroid hormone secretion, to maintain calcium and phosphorous balance. Renal hyperparathyroidism (rHPT) is a common complication of CKD characterized by derangements in the homeostasis of …

Day 1: Ranson’s Criteria vs APACHE Scoring System Ranson’s criteria are used to predict severity and mortality of acute pancreatitis.  The criteria with 11 parameters are used to assess the severity of alcoholic pancreatitis. The 5 parameters on admission are age older than 55 years, WBC count greater than 16,000 cells/mm^3, blood glucose greater than 200 mg/dL (11 mmol/L), serum AST greater than 250 IU/L, and serum LDH greater than 350 IU/L. At 48 hours, the remaining 6 parameters are: serum calcium less than 8.0 mg/dL (less than 2.0 mmol/L), hematocrit fall greater than 10%, PaO2 less than 60 mmHg, …

35 y/o year old female with no past medical history presenting to the emergency department with abdominal pain. She states the pain started off intermittently 10 months ago but has been constant over the last month. She is “always in pain” and feels it diffusely throughout the abdomen. No medications have worked and no position makes it better or worse. Patient was seen by PCP and a gastroenterologist, where many tests and exams were done but all came out negative. She has tried cutting out dairy, wheat, and meat with no relief. She is worried and anxious that something is …