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Calcium Flashcards

1
Q

Calcium overload lead to

A

Cell death, mitochondrial pore opening, defective electron transport chain

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2
Q

What two way do calcium enter the cell

A

Ligand gated channels, voltage gated channels

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3
Q

Ligand gated channels are controlled by

A

Hormones and neurotransmitter

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4
Q

Voltage gated channels are controlled by

A

Electric membrane potiental

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5
Q

How does Ca exit the cell

A

ATP dependent Ca pump, Na and Ca exchanger

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6
Q

What are the two types of Extracellular calcium

A

Diffusible and not diffusible

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7
Q

Two types of diffusible Extracellular calcium

A

Free ionized calcium and complex

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8
Q

What is the most biologically active calcium

A

Free / ionized calcium

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9
Q

What are the functions of free/ ionized calcium

A

Neuron action potiental, muscle contractions, hormone secretion, blood coagulation, intracellular functions

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10
Q

Complex Extracellular calcium is

A

Bound to non protein anions

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11
Q

Examples of complex calcium

A

Citrate, lactate, phosphate

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12
Q

Which calcium is electrically neutral

A

Complexed

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13
Q

Which calcium acts a buffer storage pool

A

Protein bound

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14
Q

Which calcium is not diffusible

A

Protein bound

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15
Q

What must you be measure to calculate total Ca in blood

A

All fractions

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16
Q

What must you check when checking total calcium in blood

A

Fasting, non lipemic, non hemolyzed

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17
Q

Free calcium is measured as

A

Ionized calcium

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18
Q

Where is most calcium

A

99% in bone

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19
Q

Where is calcium lost at

A

Gut and kidney

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20
Q

Skeleton is storage site for

A

Calcium and phosphorus

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21
Q

Major storage form for Ca and P

A

Hydroxyapatite

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22
Q

Bone resorption

A

Process osteoclasts break bone and relax minerals in blood stream

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23
Q

What can increase osteoclasts activity

A

PTH

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24
Q

99% filtered Calcium is absorbed where

A

Proximal tubule

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25
Q

PTH dependent reabsorption of Ca happens where

A

Ascending loop and distal tubule

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26
Q

Renal reabsorption

A

Process by which nephrons remove water and solutes from teh tubular fluid and return them to circulating blood

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27
Q

Phos is filtered where

A

At glomerulus

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28
Q

90% P is reaborbed where

A

Proximal tubule, 10% excreted

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29
Q

PTH decreases or increases amount of phs that can be reabsorbed from tubule

A

Decreases

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30
Q

What are the hormones that regulate calcium

A

PTH, Vitamin D, Calcitonin, PTH related protein

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31
Q

PTH regulates

A

Minute to minute ice

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32
Q

PTH secreted by

A

Parathyroid glands and chief cells

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33
Q

PTH can help prevent

A

Over correction

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34
Q

What happens to PTH if there is decreased Calcium

A

Parathyroid glands will increased PTH in body to increase calcium

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35
Q

Increased PTH will do what to calcium

A

Increased Calcium

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36
Q

List the ways that PTH increase Calcium

A

Calcium resorption in bone, tubular calcium reabsorption, activate calcitrol to increase reabsorption Ca and P in gut

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37
Q

If there is an increase in Ca what happen to PTH

A

Decreases

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38
Q

If a patient with hypercalcemia, it is appropriate for PTH to be

A

Low

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39
Q

If a patient with hypercalcemia it is inappropriate for PTH to be

A

High

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40
Q

PTH will increase or decreased P

A

Decrease

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41
Q

PTH will increase or decrease Ca

A

Increase

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42
Q

PTH will increase or decrease calcitrol

A

Increase

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43
Q

Calcitrol is the active form of

A

Vitamin D3

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44
Q

Calcitrol is a fat soluble vitamin obtained from

A

Diet

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45
Q

Calcitrol is activated in

A

Kidney

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46
Q

Calcitrol does what to Ca and Phos

A

Increases

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47
Q

Lesser actions of calcitrol

A

Increases resorption of Ca and Phos from bone, and increase renal reabsorption Ca and Phs

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48
Q

Low calcitrol will stimulate

A

PTH

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49
Q

When you have vitamin D toxicity what do u expect for Ca

A

High

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50
Q

When you have vitamin D toxicity what do you expect for P

A

High

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51
Q

Calcitonin does what

A

Decrease Ca

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52
Q

What is the source of calcitonin

A

Thyroid gland - parafollicular cells

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53
Q

What is cause of humoral hyperCa of malignancy

A

PTH related protein

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54
Q

PTHrP has the same biological function as

A

PTH

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55
Q

If PTH-rp is present this is diagnostic for

A

Neoplasia

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56
Q

Concern if what with Ca and P

A

Ca x Phos greater than or equal to 60 - 80

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57
Q

Concern of Ca and P if

A

Metastatic mineralization of tissues

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58
Q

What will happen to Ca with excessive PTH

A

Increase

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59
Q

What will happen to P if excessive PTH

60
Q

What will happen to Ca with not enough PTH

A

Decrease Ca

61
Q

What will happen with not enough PTH to P

62
Q

Clinical sings of hypercalcimeia

A

PUPD and lethargy

63
Q

Na channels with hypercalcemia effects

A

Harder to depolarization, neuron is less excitable

64
Q

Renal effects of hypercalcemia

A

Nephrogenic DI, PUPD, Ca-oxalate crystals/stones

65
Q

Hypercalcemia causes the na channels to be

A

Harder to depolarize and less excitable

66
Q

Renal effects of hypercalcemia

A

Hypercalciuria

67
Q

What does hyper calciuria cause

A

Nephrogenic DI, PUPD, crystals or stones

68
Q

How can hypercalcemia cause acute kidney injury

A

Renal vasoconstriction, worsen with volume depletion

69
Q

What will you aspirate for hypercalcemia

A

Peripheral lymph nodes, liver/spleen, bone marrow

70
Q

Initial treatment of hypercalcemia

A

0.9% saline

71
Q

Fluid plan for hypercalcemia

A

% dehydration, maintenance (PUPD), loses

72
Q

Emergency treatment of hypercalcemia

A

Fluid diuresis - saline, 2-3x maintenance, K supplement

73
Q

Na will increase what excretion

A

Ca excretion

74
Q

Filtered Na competes with

A

Ca for renal tubular respiration

75
Q

Emergency treatment of hypercalcemia - Loop diuretics

A

Furosemide, Lasix - maximized Na excretion

76
Q

Loop diuretics will decrease

A

Renal Ca reabsorption

77
Q

Glucocorticoids can cause

A

Lymphocyte lysis

78
Q

Do not give steroids before

A

Having ruled out neoplasia

79
Q

How does glucocorticoid decrease Ca

A

Decrease bone and intestinal absorption and increase renal excretion

80
Q

Bisphosphonates will inhibit

A

Osteoclasts - inhibit bone resorption

81
Q

IV for ER use bisphosphonates

A

Zoledronate

82
Q

Onset of Zoledronate

83
Q

PO bisphosphonates

A

Aledronate

84
Q

Bisphosphoantes can do what to the jaw

A

Cause osteonecrosis

85
Q

Causes of hypercalcemia

A

HOGS IN YARD

86
Q

4 mechanism of hypercalcemia

A

Increase PTH, increase calcitrol, unknown, non pathological

87
Q

Hyperparathyroidism is excessive

A

Secretion of PTH

88
Q

Secondary HPTH is from

A

Renal or nutritional

89
Q

Primary hyperparathyroidism is from

A

Abnormal gland produces PTH

90
Q

Most common reason for primary hyperparathyroidism

A

Adenoma/hyperplasia

91
Q

PHPTH DX

A

PTH inappropriately increased in the face of hypercalcemia

92
Q

PTH is normal in what percent of dogs

93
Q

PHPTH dogs signalment

A

Middle to older aged Keeshonds

94
Q

Clinical signs of PHPTH

A

Asymptomatic, PUPD, lower UT, weakness

95
Q

PHPTH DX from ultrasound neck

A

On large gland 3 -23 mm

96
Q

PHPTH treatment

A

Parathyroidectomy

97
Q

What do you monitor post op Parathyroidectomy

A

Monitor iCa

98
Q

PHPTH Treatment alternatives

A

Ethanol or heat ablation

99
Q

Secondary HPTH what do you expect to dins

A

Hypertrophy of all 4 gland

100
Q

In early kidney disease what is the calcitrol

A

Low levels

101
Q

Late renal disease there is an increase in

A

Phosphorus

102
Q

What is the PTH and Ca in early renal disease

A

Increased PTH and decreased CA

103
Q

Clinical consequences of secondary HPTH

A

Progression of renal disease and bone demineralization

104
Q

TCA can be increased in renal disease due to

A

Binding of inorganic ions changes and dehydration

105
Q

ICa can be what in renal disease

A

Increase or decrease or normal

106
Q

Nutritional secondary HPTH - what can be abnormal

A

Low Ca, Low Vitamin D, Increase Phosphorus

107
Q

What is the most common cause of hypercalcemia in adult dogs

108
Q

Neoplasia mechanism of hypercalcemia

A

Humoral hypercalcemia of malignancy and osteolysis

109
Q

Hypervitaminosis D will increase

A

Ca and P absorption

110
Q

Causes of hyper vitamin D

A

Vit D rodenticide, anti-psoriasis cream, diet

111
Q

Some clinical features of increase in vitamin D

A

Acute PUPD, acute renal failure, tissue mineralization

112
Q

Granulomatous disease mechanism

A

Stimulate macrophages produces calciferol

113
Q

Causes of granulomatous disease

A

Infections, sterile panniculitis, granulomatous inflammation

114
Q

Most common cause of increase Ca in cats

A

Idiopathic

115
Q

Clinical signs of high ca in cats - idiopathic

A

Asymptomatic, GI, constipation, stones

116
Q

Treatment of idiopathic hypercalcemia in cats

A

1st diet change, increase in fiber and decrease in cats

117
Q

Secondary treatment options for idiopathic increase in calcium in cats

A

Prednisiolone or PO biphosphates

118
Q

What is the tCA of addition in dogs

A

Mild increase and normal ice

119
Q

Additions disease is also known as

A

Hypoadrenocritcism

120
Q

The clinical signs of addisions are not due to

A

Hypercalcemia

121
Q

Non pathological increase in Ca is found in

A

Young and growing animals

122
Q

Spurious causes of hypercalcemia

A

Hemolysis, lipemia

123
Q

With hypocalcemia, the na Channels are more likely to

A

Open and easier to depolarize and neuron is more excitable

124
Q

Calcium is involved in the release of

A

Ach during neuromuscular transmission

125
Q

With a decrease in CA there is an increase in

A

Nervous system excitability

126
Q

Decrease calcium can cause spontaneous

A

Nerve discharge which leads to muscle contraction n

127
Q

Clinical manifestation of low calcium

A

Muscle tremors, facial rubbing, restless, seizures, hyproexia weight loss

128
Q

Emergency treatment for hypcalcemia

A

10% Calcium gluconate IV

129
Q

Maintenance treatment for primary hypoPTHism

A

Calcitrol and calcium carbonate

130
Q

Disease that cause hypcalcemia

131
Q

PEEARS

A

Primary hypoPTHism, eclampsia, ethylene glycol toxicity, acute pancreatitis, renal failure, Severe fut disease

132
Q

4 mechanisms of low calcium

A

Low PTH, low Calcitrol, increase utilization of Ca, or increase calcium consumption

133
Q

Hypoparathyroidism is decreased

A

Secretion of PTH

134
Q

Primary hypoparathyroidism is

A

Destruction or atrophy of parathyroid glands - usually immune mediated

135
Q

What does blood look like with primary hypoparathyroidims

A

Low PTH, Low Ca, normal to increase Phos

136
Q

What does blood look like with primary hypoparathyroidims

A

Low PTH, Low Ca, normal to increase Phos

137
Q

Primary HypoPTHism is in what signalment

A

Young , femal dogs

138
Q

Clinical signs of HypoPTHism can worsen with

A

Excitement , exercise, petting

139
Q

Treatment of primary hypoparathyroidism

140
Q

Example of decrease gut absorption of Vitamin D

A

Small intestinal lymphangiectasia

141
Q

SI malabsorption clinical signs

A

Weight loss, vomiting/diarrhea, actives

142
Q

PLE

A

Panhypoproteinemia, lymphopenia, hypocholesterolemia, decrease TCA and ice

143
Q

Cannot predict calcium from

144
Q

Renal disease mechanisms hypocalcemia

A

Decreased renal activation Calcitrol, hyperphosphatemia, complexed Ca

145
Q

Mechanisms of eclampsia with low Ca

A

Parathyroid glands unable to response to acute increase in Ca demand, lactating patients

146
Q

Ethylene glycol toxicity

A

Metabolites of EG chelate Ca into Ca oxylate

147
Q

Acute pancreatitis with hypocalcemia is due to

A

Precipitation of Ca soaps - saponification of peripancreatic fat

Endocrine (7 decks)

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