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Secondary Electrolytes > Calcium > Flashcards

Calcium Flashcards

1
Q

What is calcium for?

A

Muscle contraction, neural transmission, blood coagulation, enzymatic reactions, structure and blood pressure.

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2
Q

Where is it stored/where does it come from?

A

99% stored in bone, 1%in blood and ECF

All comes from diet.

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3
Q

What forms is it in in the body?

A
  • Free/ ionized calcium 45%
  • Bound to proteins (mostly albumin) 40%
  • Complexed to anions (citrate, phos, bicarb, lactate) 15%
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4
Q

Why is ionized calcium best for determining Ca disorders?

A

It is a more sensitive and specific marker for Ca disorders than total calcium.

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5
Q

Decreased ICA?

A

Myocardial function is impaired

Neuromuscular irritability - tetany (muscle spasms)

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6
Q

Name 3 hormones involved in calcium regulation.

A 
Parathyroid hormone (PTH)
Vitamin D3 (sunlight, diet)
Calcitonin (thyroid)
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7
Q

What organs are involved in calcium regulation?

A

Skeleton, kidneys (hydroxylation of vit D, reabsorption in tubules), Small intestine (absorbs Ca from diet, affected by vit D metabolism)

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8
Q

What affect does PTH have when ICA is decreased?

A

Bone: activates resorption via osteoclasts.
Kidney: Increases tubular reabsoprtion of Ca in kidney, and excretion of phosphate.
Small intestine: absorption of Ca and vit D(1,25).

Negative feedback; stopped by increased Ca.

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9
Q

What is 1,25-dihydroxy Vitamin D?

A

Active for of vitamin D3; enhances absoprtion.

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10
Q

Calcitonin

A
  • Sercreted by “C” cells of thyroid.
  • Stimulated by increase in blood Ca.
  • “Tones” down calcium (inhibits actions of PTH and vit D)
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11
Q

Primary hyoparathyroidism

A

Lack of PTH, PT gland destruction or removal, vit D metabolism affected.

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12
Q

Hypomagnesemia

A

Inhibits PTH secrection, impairs PTH action at receptor sites on the bone, causes vit D resistance.

More common in hospitalized patients.

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13
Q

Hypoalbuminemia

A

Only result reported from total Ca.

Causes: chronic liver disease, nephrotic syndrome and malnutrition.

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14
Q

Acute pancreatitis cause

A

Hypocalcemia; increase intestinal binding of Ca due to increase in lipase.

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15
Q

Chronic renal disease

A

Hyperphosphatemia (binds with Ca), due to defective vit D metabolism.

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16
Q

Pseudohypoparathyroidism

A

PTH reacts normal but target tissues response is impaired.

17
Q

What patients are at risk for hypocalcemia?

A

Surgical and the critically ill (due to acid-base imbalances)

18
Q

Hypocalcemia in neonates

A

High levels at birth with rapid decline by day 3, adult levels by day 7.

Reduced bone growth and rickets if prolonged.

19
Q

Hypercalcemia

A

Hyperparathyroidism, malignancies, hyperthyroidism, increased vit D, thiazide diuretics, prolonged immobilization, multiple myeloma, benign familial hypocalcuria, chronic renal failure.

20
Q

Conditions increasing risk of osteoporosis

A

Poor nutrition, vit D disorder, inadequte exercise during growth, endocrine disorders, immobilization, multiple myeloma, heparin therapy, rheumatoid arthritis.

21
Q

Symptoms of hypercalcemia

A

Serum Ca >3mmol/L:

- Neurological, GI, renal, increased blood pressure

22
Q

Treatment of hypercalcemia

A

Estrogen replacement, parathyroidectomy, increased salt and water intake (increases excretion), bisphosphonates (prevents bone resorption)

23
Q

What type of specimen is required for total Ca?

A

Serum or lithium heparin plasma

24
Q

What type of specimen is required for ICA?

A

Collect anaerobically, heparinized whole blood preferred, serum from sealed collection tubes if clotted and spun w/in 30 min (tested asap)

25
Q

Requirements for a urine Ca

A

Timed and acidified, random for Ca/creat ratios

26
Q

Methods for total Ca measurement

A

Reference method: AAS - atomic absorption spectro

Colorimetric: CPC (ortho-cresolphthalein complexone); arsenazo III dye

27
Q

What interferes with Ca testing?

A

Hemolysis > 2g/L

28
Q

Reference ranges for Ca

A

0-10dys: 1.75-3.0
10dys-12yrs: 2.2-2.7
Adult: 2.15-2.5

24hr urine: 2.5-7.5

Critical: <1.70 or >3.00

29
Q

ICA reference range

A

Adult: 1.16 - 1.32

Critical <0.80

Secondary Electrolytes (4 decks)

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