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CS endocrinology > Ca and vitamin D > Flashcards

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
Q

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

A

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

26
Q

Breeds associated with idiopathic hypercalcaemia

A

Long-haired breeds - DLH, himalayan, Persion, Maine coon

27
Q

Which vitamin D is most commonly measured

A

25-hydroxy-vitamin D3 (not biologically active)

28
Q

What is the biologically active form of vitamin D

A

1, 25-dihydroxy vitamin D

29
Q

Diet management of cats with idiopathic hypercalcaemia

A

Canned diets - higher water intake and larger urine volume which could aid calciuresis and decrease risk of urolithiasis

30
Q

Action of bisphosphonates

A

decreasing osteoclastic bone resoprtion

31
Q

Treatment of idiopathic hypercalcaemia (in order)

A

Diet management
Bisphosphonates
Glucocorticoids

32
Q

Action of glucocorticoids in decreasing calcium

A

Decrease intestinal absoprtion
Decrease renal tubular absoprtion
Decrease skeletal mobilisation of calcium

33
Q

Signalement primary hyperparathryoidism in cats

A

Age - 8-17 yr
Breed - DSH (50%), Siamere (42%)
Sex - simillar distribution, slightly more MN

34
Q

Treatment of primary hyperparathryoidism (3)

A

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
Q

Age and Breed for primary hyperparathryoidsm in dogs

A

Median age 11.2yr

Keeshond have a familial predisposition

36
Q

Acute management of severe hypercalcaemia

A

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
Q

False increased ionised calcium concentration

A

Lipemia, icterus

stroage (red cell metabolism) leads to decrease pH and increased ionised calcium

38
Q

What mediated Mg uptake from intestines

A

PTH in conjunction with 1, 25 dihydroxycholecalciferol

39
Q

Cause of primary hypoparathryoidism in dogs

A

Likley immune-mediated

40
Q

Co-factor for PTH release from parathryoid gland

A

Magnesium

41
Q

8 common causes of hypocalcaemia

A 
Hypoalbuminemia
AKI/CKD
Acute pancreatitis - prognostic indicator 
Eclampsia - 2 weeks post partum 
hyperthyroidism
urinary tract obstruction 
Individual variation
Primary hypoparathyroidism
42
Q

7 less common causes of hypocalcaemia

A

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
Q

Pathophysiological mechanism of clinical signs relating to hypocalcaemia

A

Nervous system is more excitable (increased permeability to sodium&raquo_space;> decreased threshold potential)

44
Q

Clincal signs associated with hypocalcaemia (6)

A 
Nervous
Facial muscle twitch 
Facial rubbing 
Muscle cramps
Stiff gait 
Seizures
45
Q

Causes of hyperphosphatemia (7)

A 
CKD - reduced GFR
Young/growing animal
Vitamin D toxicosis
hypoparathyroidism
Tumour lysis
Phosphate enema
Osteolytic bone lesion
46
Q

Causes of hypophosphataemia (three mechanisms with examples)

A

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
Q

Indication for vitamin D therapy pst parathyoidectomy (2 studies)

A

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
Q

Onset of action vitamin D supplementation

A

1-4 days

49
Q

Signalement dogs with hypoparathryoidism (3)

A

Mean 6 yr
Miniature schnauzer, poodle, GSD
Female

50
Q

Diagnosis of primary hypoparathyroidism

A

Low ionised calcium and normal (inappropriate) or low PTH

CS endocrinology (4 decks)

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