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Ca and vitamin D Flashcards

1
Q

Forms of calcium in circulation

A

50% ionised, 10% chelated, 40% plasma protein bound

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2
Q

Effect increased ionised calcium on PTH, kidney, gut, bone, calcitonin

A

PTH - decreased
Kidney - increased urinary excretion
Gut and bone - no effect
Calcitonin - increase

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3
Q

Effect decreased ionised calcium on PTH, kidney, gut, bone, calcitonin

A

PTH - Increased
Kidney - increased tubular resoprtion of Ca++
Gut and bone - no effect
Calcitonin - decrease

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4
Q

Effect increased vitamin D on PTH, kidney, gut, bone, calcitonin

A

PTH, kidney, calcitonin - no direct effect
Gut - increased absoprtion of Ca++
Bone - mobilise Ca release from bone

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5
Q

Effect increased PTH on kidney, gut, bone, calcitonin

A

Kidney - increase Ca++ resportion and vitamin D production
Gut - indirect increased absoprtion of Ca (via vitamin D)
Bone - mobilises Ca++ release from bone
Calcitonin - no effect

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6
Q

Effect increased calcitonin on PTH, kidney, gut, bone

A

PTH, gut - no effect
Kidney - decreased tubular resorption
Bone - Inhibits bone resorption and Ca release

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7
Q

Specificity and senstivity for predicting ionised hypercalcaemia from total calcium in the cat

A

100% specific

30% or less sensitive

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8
Q

Which type of blood is best to analyse ionised calcium

A

Serum preferable

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9
Q

Cause of falsely low ionised calcium (2)

A

Exposure to air increases pH and falsely lowers Ca

EDTA and anticoagulant citrate chelate calcium

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10
Q

DDX hypercalcaemia in dogs (9)

A

HARD IONS G
Hyperparathryoidism, Addisons, Renal disease, Vitamin D toxicity, Idiopathic/iatrogenic, Osteolytic lesions, neoplasia, spurious, Granulomatous

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11
Q

DDX hypercalcaemia in cats (3)

A

Malignancy, CKD, idiopathic

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12
Q

Processing of PTH

A

Frozen serum sample, same sample as measured [Ca]

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13
Q

Classification of hypercalcaemia of malignancy

A

1) Humoral factors - release of PTHrp from tumour
2) haematologic malignancy of bone marrow causing osteolytic lesions
3) hypercalcaemia by metstasis of solid bone tumours

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14
Q

Tumours associated with PTHrp (4)

A

T cell lymphoma (dogs most common)
Apopcrine gland adenocarcinoma of the anal sac
Pulmonary carcinoma (cats most common) and other carcinoma
Melanoma

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15
Q

Tumour associated with haematologic malignancy of bone marrow and osteolytic lesions

A

Multiple myeloma

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16
Q

Hypercalcaemia due to metastasis of solid bone (2)

A

malignant mammary adenocarcinoma

SCC

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17
Q

Clinical signs of hypercalcaemia - prevalence in dogs and cats (4)

A 
Anorexia (88% d, 70% c)
PU/PD (68% d, 19% c)
Vomiting (53% d, 20% c)
Dysuria - urolith associated (21% c)
Muscular weakness/twitching (23% d, no cats)
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18
Q

Alterations in serum vitamin D, PTH, PTHrp and phosphorus with idiopathic hypercalcaemia

A

Vitamin D, PTH - normal/decreased

PTHrp and phosphorous - normal

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19
Q

Alterations in serum vitamin D, PTH, PTHrp and phosphorus with vitamin D toxicity

A

Vitamin D - increased
PTH - low/normal/decreased
PTHrp - normal
Phosphorus - normal/increased

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20
Q

Alterations in serum vitamin D, PTH, PTHrp and phosphorus with humoral hypercalcaemia of malignancy

A

Vitamin D - decreased
PTH - low
PTHrp - increased
Phosphorus - normal or decreased

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21
Q

Alterations in serum vitamin D, PTH, PTHrp and phosphorus with Primary hyperparathryoidism

A

Vitamin D - not reported
PTH - High
PTHrp - normal
Phosphorus Decreased

22
Q

Alterations in serum ionised calcium vitamin D, PTH, PTHrp and phosphorus with Renal insufficiency

A 
Ionised calcium - normal or decreased
Vitamin D - decreased
PTH - high
PTHrp - normal 
Phosphorus - normal or increased
23
Q

Alterations in serum vitamin D, PTH, PTHrp and phosphorus with Granulomatous disease

A

Vitamin D - increased
PTH - low
PTHrp - normal
Phosphorus - increased/normal

24
Q

Alterations in serum vitamin D, PTH, PTHrp and phosphorus with hypoadrenocorticism

A

Vitamin D - not reported
PTH - low
PTHrp - normal
Phosphorus - increased

25
Alterations in serum vitamin D, PTH, PTHrp and phosphorus with osteolytic disease
Vitamin D - decreased PTH - low PTHrp - normal Phosphorus - increased
26
Breeds associated with idiopathic hypercalcaemia
Long-haired breeds - DLH, himalayan, Persion, Maine coon
27
Which vitamin D is most commonly measured
25-hydroxy-vitamin D3 (not biologically active)
28
What is the biologically active form of vitamin D
1, 25-dihydroxy vitamin D
29
Diet management of cats with idiopathic hypercalcaemia
Canned diets - higher water intake and larger urine volume which could aid calciuresis and decrease risk of urolithiasis
30
Action of bisphosphonates
decreasing osteoclastic bone resoprtion
31
Treatment of idiopathic hypercalcaemia (in order)
Diet management Bisphosphonates Glucocorticoids
32
Action of glucocorticoids in decreasing calcium
Decrease intestinal absoprtion Decrease renal tubular absoprtion Decrease skeletal mobilisation of calcium
33
Signalement primary hyperparathryoidism in cats
Age - 8-17 yr Breed - DSH (50%), Siamere (42%) Sex - simillar distribution, slightly more MN
34
Treatment of primary hyperparathryoidism (3)
1) Surgical excision - 94% success (Normally single hyperfunctioning adenoma in one parathyroid gland) 2) Percutaneous ultrasound ethanol ablation (mass >3mm) 72% success 3) Percutaneous radiofrequency heat ablation (90% success)
35
Age and Breed for primary hyperparathryoidsm in dogs
Median age 11.2yr | Keeshond have a familial predisposition
36
Acute management of severe hypercalcaemia
1) Nacl 5-10 ml/kg /hr (Na competes with Ca to decrease renal tubular absoprtion) 2) Furosemide once hydrated - calciuresis 3) Glucocorticoids - most effective with malignancy 4) Bisphosphonates - reduce ostroclastic activity and induce osteoclast apoptosis 5) Calcitonin - inhibits osteoclastic activity and decrease renal absorption of Ca.
37
False increased ionised calcium concentration
Lipemia, icterus | stroage (red cell metabolism) leads to decrease pH and increased ionised calcium
38
What mediated Mg uptake from intestines
PTH in conjunction with 1, 25 dihydroxycholecalciferol
39
Cause of primary hypoparathryoidism in dogs
Likley immune-mediated
40
Co-factor for PTH release from parathryoid gland
Magnesium
41
8 common causes of hypocalcaemia
``` Hypoalbuminemia AKI/CKD Acute pancreatitis - prognostic indicator Eclampsia - 2 weeks post partum hyperthyroidism urinary tract obstruction Individual variation Primary hypoparathyroidism ```
42
7 less common causes of hypocalcaemia
EDTA sample - chelation Ethylene glycol toxicity - oxalate complexes with ca GI disease - malabsoprtion Tumour lysis syndrome Iatrogenic post bilateral thyroidectomy Sepsis - inversely correlated with outcome Nutritional secondary hyperparathryoidism (vitamin D deficiency)
43
Pathophysiological mechanism of clinical signs relating to hypocalcaemia
Nervous system is more excitable (increased permeability to sodium >>> decreased threshold potential)
44
Clincal signs associated with hypocalcaemia (6)
``` Nervous Facial muscle twitch Facial rubbing Muscle cramps Stiff gait Seizures ```
45
Causes of hyperphosphatemia (7)
``` CKD - reduced GFR Young/growing animal Vitamin D toxicosis hypoparathyroidism Tumour lysis Phosphate enema Osteolytic bone lesion ```
46
Causes of hypophosphataemia (three mechanisms with examples)
Decreased intestinal absorption - malabsoprtion, V/D, phosphate enema, decreased vitamin D Increased urinary excretion - DM, HAC, fanconi syndrome, primary hyperparathyroidism Transcellular shift - insulin/parental glucose
47
Indication for vitamin D therapy pst parathyoidectomy (2 studies)
1) Armstong 2019 - no support for post-op calcitriol 2) Dear 2017 - moderate association iCa 1.72-1.81 mmol/l pre with ica< 1.00 post op (dogs with higher initial iCa should be treated perioperatively with vitamin D)
48
Onset of action vitamin D supplementation
1-4 days
49
Signalement dogs with hypoparathryoidism (3)
Mean 6 yr Miniature schnauzer, poodle, GSD Female
50
Diagnosis of primary hypoparathyroidism
Low ionised calcium and normal (inappropriate) or low PTH

CS endocrinology (4 decks)

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