Ca, P & Mg

Question 1

Ca normal ranges

Answer 1

9.6-10.4

Question 2

Remember Calcium Calms so it has a

Answer 2

stabilizing effect on the neuromuscular cells

Question 3

Ca is involved in

Answer 3

cardiac contraction
neuromuscular activity
blood coagulation

Question 4

When Ca levels are high, Phos levels are

Answer 4

low

Question 5

Parathyroid hormone (PTH)
Calcitonin
know these

Question 6

Hypercalcemia (>10.4) results from

Answer 6

↑ resorption of Ca from the bones, ↑ intestinal absorption of Ca, and retention of Ca by the kidneys.

Question 7

Hypercalcemia is caused by

Answer 7

*Hyperparathyroidism
*↓ serum phosphorus
*Some cancers
*Medications: Thiazide diuretics
*Steroid therapy – Steroids promotes Ca loss from the bone

Question 8

Hypercalcemia Signs and Symptoms (TOO much Calm!)

Answer 8

*High Ca levels cause ↓ neuromuscular excitability → ↓ GI motility (constipation & diminished bowel sounds), lethargy, depression – progressing to stupor and coma
*Calcium containing kidney stones (#1 cause of kidney stones)
*Pathologic fractures
*AV heart blocks

Question 9

hypocalcemia treatment

Answer 9

Calcitonin
Bisphosphonates
Loop diuretics
Fluids (NS)
Rapid reversal
Safety: Weakness, neuro checks

Question 10

Hypocalcemia (<8.5) is caused by

Answer 10

*Parathyroid or thyroid surgery; Hypoparathyroidism
*↓ Ca consumption (malnutrition) & Vitamin D deficiency (sun exposure)
*Abuse of antacids (Magnesium) & laxatives (Phos)
*Diarrhea & diuretics
*↓ albumin (liver disease, alcoholism)
*Prolonged NG suction leads to Metabolic Alkalosis
*Magnesium imbalances

Question 11

Signs and Symptoms of hypocalcemia (Not calm enough!)

Answer 11

CNS excitability

Question 12

CNS excitability leads to:

Answer 12

*Irritability; numbness and tingling around the mouth, hands, and feet;
*Tetany of the face and extremities (carpopedal spasm of the fingers and hands).
Assessment: Trousseau’s sign: BP cuff is placed around on the arm and inflated to a pressure greater than the systolic blood pressure and hold in place for several minutes
Chvostek’s sign: facial tap causes cheek tetany.
*Hyperactive deep tendon reflexes
*Abd distention/cramps

Question 13

Hypocalcemia Treatment (Treat the cause!)

Answer 13

*Medications: V Calcium Gluconate or Calcium chloride
Correction of magnesium deficiency; Vit D therapy
*Monitor Ca level following thyroid and parathyroid surgery

Question 14

Hypophosphatemia (<2 mg/dL) is caused by

Answer 14

increased renal excretion (kidney injury or renal disease)

Question 15

Hypermagnesemia (>2.1 mEq/L) is caused by

Answer 15

Rare, but usually caused by renal injury/renal disease or excessive intake of magnesium containing antacids/laxatives