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Chemical Pathology > Calcium > Flashcards

Calcium Flashcards

1
Q

What is the normal range of plasma calcium?

A

2.2-2.6mmol/l

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2
Q

What percentage of plasma calcium is bound to albumin?

A

50%

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3
Q

Name the two main hormones involved in calcium metabolism

A

Parathyroid hormone (PTH), calcitriol (1,25-dihydroxy vitamin D2)

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4
Q

State the four effects of PTH

A

Increases renal tubular 1alpha hydroxylation of vitamin D, mobilises calcium from bone, increases renal calcium absorption, increases renal phosphate excretion

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5
Q

State the two main effects of calcitriol

A

Increases calcium and phosphate absorption from the gut, bone remodelling

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6
Q

What is primary hyperparathyroidism?

A

Increased PTH - usually from parathyroid adenoma

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7
Q

Describe the blood results in primary hyperparathyroidism

A

Increased calcium, decreased phosphate, increased or inappropriately normal PTH, increased or normal alkaline phosphatase, normal vitamin D

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8
Q

What is secondary hyperparathyroidism?

A

Renal osteodystrophy

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9
Q

Describe the blood results in secondary hyperparathyroidism

A

Decreased or normal calcium, increased phosphate, increased PTH, increased alkaline phosphatase, normal vitamin D

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10
Q

What is tertiary hypoparathyroidism?

A

Autonomous PTH secretion post-renal transplant

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11
Q

Describe the blood results in tertiary hyperparathyroidism

A

Increased calcium, decreased phosphate, increased PTH, increased or normal alkaline phosphatase, normal vitamin D

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12
Q

State two causes of hypoparathyroidism

A

DiGeorge syndrome, post-thyroid surgery

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13
Q

Describe the blood results in hypoparathyroidism

A

Decreased calcium, increased phosphate, decreased PTH, decreased or normal alkaline phosphatase, normal vitamin D

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14
Q

Describe the blood results in vitamin D deficiency

A

Low calcium, low phosphate, increased PTH, increased alkaline phosphatase, low vitamin D

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15
Q

Describe the blood results in Paget’s disease of bone

A

Normal calcium, normal phosphate, normal PTH, increased alkaline phosphatase, normal vitamin D

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16
Q

Describe the blood results in osteoporosis

A

All normal

17
Q

Describe the symptoms of hypercalcaemia

A

Renal stones, abdominal pain, psychiatric disturbance, bone pain, polyuria, muscle weakness

18
Q

What is the main cause of hypercalcaemia with increased albumin and urea?

A

Dehydration

19
Q

What is the underlying cause of hypercalcaemia with low phosphate and low or normal albumin?

A

Primary or tertiary hyperparathyroidism

20
Q

Name three causes of hypercalcaemia with low albumin, high phosphate, and increased ALP

A

Bone metastases, thyrotoxicosis, sarcoidosis

21
Q

Name three causes of hypercalcaemia with low albumin, high phosphate, and normal ALP

A

Myeloma, excess vitamin D, sarcoidosis, milk alkali syndrome

22
Q

State four causes of hypocalcaemia with hyperphosphataemia

A

Chronic kidney disease, hypoparathyroidism, pseudohypoparathyroidism, hypomagnesaemia

23
Q

State four causes of hypocalcaemia with normal or low phosphate

A

Osteomalacia, acute pancreatitis, overhydration, respiratory alkalosis

24
Q

Describe the clinical features of hypocalcaemia

A

Perioral paraesthesia, carpopedal spasm, neuromuscular excitability, Trousseau’s and Chvostek’s signs

25
Q

What is the treatment for hypocalcaemia?

A

Oral calcium or 10% calcium gluconate IV

If chronic kidney disease: alfacalcidol

26
Q

State five risk factors for renal stones

A

Dehydration, abnormal urine pH (e.g. high meat intake, renal tubular acidosis), increased excretion of stone constituents, urine infection, anatomical abnormalities

27
Q

State the five most common types of renal stones

A

Mixed calcium (45%), calcium oxalate (35%), struvite (triple phosphate, 10%), uric acid (5%), cysteine (1-2%)

28
Q

State four radio-opaque renal stones

A

Mixed calcium, calcium oxalate, struvite, calcium phosphate

29
Q

State two radio-lucent renal stones

A

Uric acid, cysteine

30
Q

What investigations should be performed for recurrent renal stones?

A

Serum creatinine, calcium, phosphate, urate, PTH
Stone analysis
Urine sample for pH, MC&S, amino acids, albumin
24h urine volume, calcium, oxalate, citrate, urate

Chemical Pathology (16 decks)

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