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Sidenote, OTC deficiency is the only X-linked recessive urea cycle deficiency (all others are autosomal recessive) and it's the most common
I'm confused about the phosphate level in questions like these. Decreased calcitriol would decrease phosphate absorption while PTH decrease lowers phosphate excretion. I'm assuming that the PTH decrease has the greater effect with serum phosphate levels?
PTH = "Phosphate trashing hormone" if PTH is high Phosphate must be low - they are always opposite (unless d/t renal failure then Phosphate will be high - kidneys will be unable to get rid of phosphate)
So low Ca d/t low PTH does not effect 25 H. Vit D ... only 1,25 H Vit D (active Calcitriol)?
Clarification because I was confused: PTH stimulates kidney to produce 1,25-(OH)2 D3 (calcitriol) via 1α-hydroxylase in proximal convoluted tubule. Therefore, without parathyroid glands, low PTH, 25,D is not converted and therefore not down (normal or up). phosphate "trashed" by PTH as eloquently stated above.
Here the primary defect is high up from the parathyroid gland, there is decresed or no PTH which normally trashes phosphate but not in this case so serum PHOSPHATE INCREASES and the serum calcium is low because PTH should have prevented the urine calcium so there is calciuria and no resorption from bone-LOW CALCIUM, Vitamin-D is independent of PTH so stays NORMAL
If we assume that they are not carriers (in the recessive case)
Then how came it can be AR？！！
^exactly what's said above here. I think x-linked recessive is the least likely, but not impossible.
Catecholamines activate the Na/K pump, which will drive K inside.
Read online that catachelamines are released following tonic clonic seizures. Besides that, BP of 180/100 could indicate that catecholamines are circulating.
This mechanism is why giving albuterol for hyperkalemia works
Why does this guy have increased catecholamines tho
His SNS activity is seriously increased --> increased catecholamines.
Why is his SNS activity increased? Is the BP literally the only hint?
Alcohol withdrawal creates a hyper- catecholaminergic state + Seizures do that as well.
My best guess is that withdrawal puts the body in a state of stress (same for seizures) and with stress you have release of catecholamine which we'll see in the BP and the hypokalemia.