Calcium and other electrolye Disorders Flashcards
acidosis ____ ionized Ca
increases
alkalosis ____ ionized Ca
decreases
calcium lives in the _____.
blood
ionized Ca is the _____ form.
bioactive
Normal response to low calcium in body?
Parathyroid –> PTH –> liver and renal tubules –> increase Ca absorption, P secretion
PTH –> bone –> osteoclast release of Ca and P
Vit D ingested –> liver –> kindey –> 1,25-hydroxycholecalciferol –> SI –> increase Ca and P absorption
High PTH?
High Ca and low P
Hypervitaminosis D?
High Ca and P
PTH tumor + kidney failure?
start with High Ca, low P –> tubules start to fail –> p retention —> high Ca and P
causes of hypercalcemia?
malignancy #1 primary hyperPTH #2 osteolytic metastasis hyperVitD granulomatous disease iodiopathic in cats (responds to pred)
hypercalcemia signs?
anorexia vomiting depression weakness PD/PU dehydration abdominal discomfort constipation urinary calculi "not feeling well" patient
four criteria for automatic hospital emission?
anorexia, vomiting, depression, and weakness
hypercalcemia work up includes rectal exam, why?
anal gland carcinomas are the more common cause of hypercalcemia of malignancy in the dog
PTH level patterns
Increase PTH with primary and renal secondary hyperPTH
Can have low PTH with hypercalcemia of malignancy
renal hyperPTH
chronic pyelonephritis common
primary PTH tumor
high Ca
low P
Normal/high PTH
hypercalcemia of malignancy
high Ca
low PTH
hypercalcemia treatment goals?
correct dehydration**
promote calciuresis
inhibit bone resoption
treat underlying dz
hypercalcemia specific treatments?
NaCl IV fluids
glucocorticoids (AFTER FNA)
bisphosphonates and thyrocalcitonin inhibit osteoclasts
plicamycin inhibits neoplasia
hypervitaminosis D treatment?
steroids (glucocorticoids decrease Gi absorption of Ca and P)
IV saline
+/- calcitonin
hypocalcemia causes?
primary hypoPTH
postpartum lactation (eclampsia)
hyperP (Acute)
hypoVitD (rare)
primary hypoPTH
hypoCa and hyperP
natural onset
main clinical disorder of hypocalcemia?
neuromuscular irritability!
muscle weakness, twitch, tetany, seizure
Fleet enema syndrome?
giving enema in obstupated animal, solution stays in colon and Ca and P are absorbed into the blood.
The hyperP precipitates the Ca and causes hypoCa –> seizure
DONT USE FLEET ENEMA IN SAs
hypocalcemia treatment?
calcium gluconate IV
hypovitD treatment?
supplementation with Vitamin D2, DHT, or Calcitriol (chronic rx)
Only __% of K is in the EXC, the rest is INC
2%
K body distribution
Most in muscle cells, also liver and RBCs
most that goes in, comes back out
Acidosis _____ EXC K
increases (INC —> EXC)
Alkalosis _____ EXC K
decreases (EXC –> INC)
hyperK leads to sustained _____.
depolarization
hypoK leads to sustained ____.
hyperpolarization
The main sign for both hyper and hypoK is ___.
muscle weakness
Changes in ECG with changing K
As K increases, atrial standstill —> v fib
As K decreases, tachycardia —> v fib
HypoK clinical signs
<2.5 K
MUSCLE WEAKNESS
lethargy, confusion, PU/PD (hypoK nephropathy), ileus, anorexia
unpredictable ECG changes
Causes of hypoK
movement into cells (insulin) GI loss (v/d) - can also cause hyperCl and metabolic acidosis Renal loss - cats with CKD
ANY ANIMAL THAT WON’T STOP VOMITING BUT DOESN’T HAVE DIARRHEA, what are you worried about?
Obstruction or pancreatitis
HypoK treatment?
KCl or KPhos (is also low P)
CRI K
Give at low rate unless trying to die, then X3 + close ECG monitoring
HyperK affects on ECG are exaggerated by?
HypoNa
HyperK signs?
MUSCLE WEAKNESS
Cardiac excitation and conduction abnormalities
bradycardia + no p waves =?
atrial standstill
HyperK main mechanisms?
too much intake
impaired excretion - AKF, Addisons
shifting out of INC to EXC
severe exercise - rhabdomyolysis –> renal tube injury
False hyperK?
When blood is allowed to clot in serum
When animals have high PLT, cushings
HyperK treatment?
Ca Gluconate!! To save heart, not lower K Bicarb - EXC --> INC but not reliable Insulin diuresis dialysis Beta agonists (EXC --> INC)
Most Na is in which space?
EXC
HypoNa
BIG PROBLEMS <120
HypoNa causes?
water gain - common
sodium loss - uncommon (Addison’s)
Acute HypoNa will affect the _____ the most!
Brain
EXC Na decreased –> Water to INC –> brain –> edema
Can cause by giving dextrose 5% in water (D5W)
HypoNa signs
weakness, apathy, dementia, stupor/coma (bad), absence of thirst, decreased skin elasticity, hypotension, hypothermia, shock, seizures, myoclonus
HypoNa classifications
Eusmolar
Hyperosmolar
Hypoosmolar
HypoNa is commonly ____.
hyperosmolar hypovolemic
2 causes of acute hypoNa
increase intake (PPD, iatrogenic) decreased water excretion (too much ADH in liver dz/lung carcinoma)
D5W
Isotonic, no Na in it
dilutes EXC
use with early CHF
can cause hypoNa
With chronic hypoNa, do not exceed rate of correction of serum Na by more than_________.
8-12 in 24 hours
Giving ____ while treating hypoNa with NaCl, helps avoid brain complications
furosemide
Addison’s dz may require ____ replacement of Na.
slow
What happens if you correct Na too fast?
Osmotic demyelination of brain
Correct slow, if it occurs slow
Correct fast, if it occurs fast
HyperNa
> 170 see problems
Hypertonic encephalopathy
HyperNa main causes?
Na gain- uncommon
H2O loss - common (dehydration)
HyperNa signs?
fever nausea, vomiting seizures coma array of neuo signs hypotension tachycardia oliguria
HyperNa types?
hypovolemic - renal/GI (v/d)
hypervolemic - due to hypertonic saline treatment
euvolemic - DI
HyperNa treatment
stop water diuresis by giving ADH to DI patient STOP hypertonic fluid CRI Give .45% NaCl or D5W IV If acute, can fix fast If chronic, must fix slowly
ECC priorities?
Volume, pH, then electrolyte correction
