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nbme24/Block 1/Question#26 (22.3 difficulty score)
An 80-year-old woman with poorly controlled ...
Hematocrit: decreased;
Serum parathyroid hormone: increased;
Serum calcitriol: decreased
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 +8 
submitted by radshopeful(17),
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jotajota94  she is also volume overloaded. more fluid leads to a decrease in Hematocrit. +5  
h0odtime  I thought PTH increases 1-alpha-hydroxylase which increases levels of 1 ,25? +1  
batmane  it's supposed to in the setting of proper kidney fxn +2  
h0odtime  Whoops +1  
avocadotoast  The decrease in GFR leads to decreased delivery of 25 dihydro vit D to the PCT and the decrease in functional renal mass limits production of 1a-hydroxylase. The increase in PO4 also stimulates FGF-23 from bone, which inhibits PO4 reabsorption and 1a-hydroxylase. +1