Calcium Flashcards
1
Q
Hypercalcemia
A
- Total serum Ca > 12 mg/dl OR ionized Ca > 1.42 mmol/L
2
Q
Primary Hyperparathyroidism
A
- Inc PTH from parathyroid
- inc Ca
- dec P
- Once kidneys get wiped out P will inc
3
Q
hypervitaminosis D
A
- Over supplementation or rat poison
- Inc Ca, Inc P
4
Q
fungal dz causing hypercalcemia
A
- blastomycosis
- histoplasmosis
5
Q
Causes of Hypercalcemia
A
- Hypercalcemia of malignancy => lymphoma and anal sac carcinoma
- Primary hyperparathyroidism
- Osteolytic metastasis => carcinomas and multiplemyelomas
- Hyper vit D
- Day-blooming Jessamine ingestion
- 2 renal hyperPTH
- Addison’s dz - not sig
- Granulomatous dz
- Idiopathic in some cats => treat with pred
6
Q
secondary renal hyperparathyroidism
A
- Kidneys become insufficient and P rises
- Rising P meets threshold and chelates free Ca
- Lower free Ca in blood increases PTH release => hyperCa
7
Q
Signs of hypercalcemia
A
- anorexia
- vomiting
- depression
- weakness
- PU/PD
- Dehydration
- abdominal discomfort
- constipation
- urinary calculi
8
Q
kidney calcification
A
not reversible
9
Q
Hypercalcemia workup
A
- Thorough HX and PE incl RECTAL
- Hemogram
- Serum chemistry panel
- UA
- Chest/abdominal rads
10
Q
Hypercalcemia
Other DX tests
A
- Bone marrow aspirate - myeloma and other tumors
- FNA of growths - granuloma/tumor
- Plasma PTH - primary hyperPTH
- PTH related peptide - cancer
- Serum EPH - myeloma
- Bence - Jones - myeloma
11
Q
PTH tumors
A
- Benign tumor more common than the malignant tumor
12
Q
Causes
Inc Ca2+ in Malignancy
A
- PTH
- Protein related-like PTH
- Osteoclast activating factor
- Vitamin D-like compounds
- granulomas
13
Q
NOT EVERY ANAL SAC CARCINOMA CAUSES ________
A
Hypercalcemia
14
Q
TX hypercalcemia
A
General guidelines
-
correct dehydration (0.9 saline for calciuresis)
- LRS has less sodium
- Promotes calciuresis
- Inhibit bone reabsorption
- Treat uderlying disorder
Specific drugs
- NaCl IV
- Glucocorticoids
- take blood sample first b/c steroids cause lymphocytolysis
- Bisphosphonates IV
- inhibits peripheral osteoclast activity
- Thyrocalcitonin
- works opposite of PTH
- Plicamycin
- not used much, anti-cancer
- NaHCO3
- not used much…..
*Furosemide no longer used
15
Q
TX vit D intoxication
A
- Glucocorticoids => antagonize Vit D
- IV saline
- +/- Calcitonin
16
Q
Hypercalcemia
Take home message
A
- Signs: PU/PD, lethargy, poor appetite; neurologic (get quiet…?)
- Common causes: paraneoplastic, primary inc PTH
- Nephrocalcinosis is a serious consequence (chronic irreversible dz)
- Primary TX: rehydrate with 0.9% saline
17
Q
Hypocalcemia
A
- total serum Ca2+ < 9.0 mg/dl OR < 1.12 mmo/L
18
Q
Hypocalcemia causes
A
- Primary HypoPTH (immune mediated hypoendocrinopathy)
- low Ca and high P
- Postpartum lactation
- Hypophosphatemia (acute)
- Hypovitamin D
- Hypoalbuminemia
- Acute hyperphosphatemia
19
Q
Hypocalcemia CS
A
- neuromuscular irritability
- Tetany
- Convulsion
- Marked weakness (bovine)
20
Q
Fleet Enema syndrome
A
- Fleet enemas contain high P and high Na
- Obstipation causes absorption of P
- Inc P breaches threshold and precipitates Ca
- Can happen in 15-20 minutes
- Causes hypocalcemic crisis => seizure
21
Q
Eclampsia
Postparturient hypocalcemia
A
- usually several days postpartum
- usually smaller dogs
- restlessness, panting, nueromuscular irritability
- easy to ID without chemistries
- Cagluconate IV => easy to hit these veins!
- CaCl more bioavailable, use less and make sure in vein!
- look out for hypoglycemia….?
22
Q
Hypocalcemia
Take home messages
A
- Muscle weakness, tetany, seizures
- Main causes
- 1 HypoPTH, Inc P, eclampsia
- TX
- Ca gluconate
- Chronic TX
- DHT, Oral Ca, Calcitriol
