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Endocrinology - 2nd year > Calcium and other electrolye Disorders > Flashcards

Calcium and other electrolye Disorders Flashcards

1
Q

acidosis ____ ionized Ca

A

increases

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2
Q

alkalosis ____ ionized Ca

A

decreases

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3
Q

calcium lives in the _____.

A

blood

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4
Q

ionized Ca is the _____ form.

A

bioactive

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5
Q

Normal response to low calcium in body?

A

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

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6
Q

High PTH?

A

High Ca and low P

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7
Q

Hypervitaminosis D?

A

High Ca and P

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8
Q

PTH tumor + kidney failure?

A

start with High Ca, low P –> tubules start to fail –> p retention —> high Ca and P

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9
Q

causes of hypercalcemia?

A 
malignancy #1
primary hyperPTH #2
osteolytic metastasis
hyperVitD
granulomatous disease 
iodiopathic in cats (responds to pred)
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10
Q

hypercalcemia signs?

A 
anorexia
vomiting
depression
weakness
PD/PU
dehydration
abdominal discomfort
constipation
urinary calculi
"not feeling well" patient
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11
Q

four criteria for automatic hospital emission?

A

anorexia, vomiting, depression, and weakness

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12
Q

hypercalcemia work up includes rectal exam, why?

A

anal gland carcinomas are the more common cause of hypercalcemia of malignancy in the dog

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13
Q

PTH level patterns

A

Increase PTH with primary and renal secondary hyperPTH

Can have low PTH with hypercalcemia of malignancy

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14
Q

renal hyperPTH

A

chronic pyelonephritis common

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15
Q

primary PTH tumor

A

high Ca
low P
Normal/high PTH

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16
Q

hypercalcemia of malignancy

A

high Ca

low PTH

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17
Q

hypercalcemia treatment goals?

A

correct dehydration**
promote calciuresis
inhibit bone resoption
treat underlying dz

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18
Q

hypercalcemia specific treatments?

A

NaCl IV fluids
glucocorticoids (AFTER FNA)
bisphosphonates and thyrocalcitonin inhibit osteoclasts
plicamycin inhibits neoplasia

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19
Q

hypervitaminosis D treatment?

A

steroids (glucocorticoids decrease Gi absorption of Ca and P)
IV saline
+/- calcitonin

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20
Q

hypocalcemia causes?

A

primary hypoPTH
postpartum lactation (eclampsia)
hyperP (Acute)
hypoVitD (rare)

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21
Q

primary hypoPTH

A

hypoCa and hyperP

natural onset

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22
Q

main clinical disorder of hypocalcemia?

A

neuromuscular irritability!

muscle weakness, twitch, tetany, seizure

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23
Q

Fleet enema syndrome?

A

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

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24
Q

hypocalcemia treatment?

A

calcium gluconate IV

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25
Q

hypovitD treatment?

A

supplementation with Vitamin D2, DHT, or Calcitriol (chronic rx)

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26
Q

Only __% of K is in the EXC, the rest is INC

A

2%

27
Q

K body distribution

A

Most in muscle cells, also liver and RBCs

most that goes in, comes back out

28
Q

Acidosis _____ EXC K

A

increases (INC —> EXC)

29
Q

Alkalosis _____ EXC K

A

decreases (EXC –> INC)

30
Q

hyperK leads to sustained _____.

A

depolarization

31
Q

hypoK leads to sustained ____.

A

hyperpolarization

32
Q

The main sign for both hyper and hypoK is ___.

A

muscle weakness

33
Q

Changes in ECG with changing K

A

As K increases, atrial standstill —> v fib

As K decreases, tachycardia —> v fib

34
Q

HypoK clinical signs

A

<2.5 K
MUSCLE WEAKNESS
lethargy, confusion, PU/PD (hypoK nephropathy), ileus, anorexia
unpredictable ECG changes

35
Q

Causes of hypoK

A 
movement into cells (insulin) 
GI loss (v/d) - can also cause hyperCl and metabolic acidosis
Renal loss - cats with CKD
36
Q

ANY ANIMAL THAT WON’T STOP VOMITING BUT DOESN’T HAVE DIARRHEA, what are you worried about?

A

Obstruction or pancreatitis

37
Q

HypoK treatment?

A

KCl or KPhos (is also low P)

38
Q

CRI K

A

Give at low rate unless trying to die, then X3 + close ECG monitoring

39
Q

HyperK affects on ECG are exaggerated by?

A

HypoNa

40
Q

HyperK signs?

A

MUSCLE WEAKNESS

Cardiac excitation and conduction abnormalities

41
Q

bradycardia + no p waves =?

A

atrial standstill

42
Q

HyperK main mechanisms?

A

too much intake
impaired excretion - AKF, Addisons
shifting out of INC to EXC
severe exercise - rhabdomyolysis –> renal tube injury

43
Q

False hyperK?

A

When blood is allowed to clot in serum

When animals have high PLT, cushings

44
Q

HyperK treatment?

A 
Ca Gluconate!! To save heart, not lower K 
Bicarb - EXC --> INC but not reliable 
Insulin
diuresis
dialysis 
Beta agonists (EXC --> INC)
45
Q

Most Na is in which space?

A

EXC

46
Q

HypoNa

A

BIG PROBLEMS <120

47
Q

HypoNa causes?

A

water gain - common

sodium loss - uncommon (Addison’s)

48
Q

Acute HypoNa will affect the _____ the most!

A

Brain

EXC Na decreased –> Water to INC –> brain –> edema
Can cause by giving dextrose 5% in water (D5W)

49
Q

HypoNa signs

A

weakness, apathy, dementia, stupor/coma (bad), absence of thirst, decreased skin elasticity, hypotension, hypothermia, shock, seizures, myoclonus

50
Q

HypoNa classifications

A

Eusmolar
Hyperosmolar
Hypoosmolar

51
Q

HypoNa is commonly ____.

A

hyperosmolar hypovolemic

52
Q

2 causes of acute hypoNa

A 
increase intake (PPD, iatrogenic)
decreased water excretion (too much ADH in liver dz/lung carcinoma)
53
Q

D5W

A

Isotonic, no Na in it
dilutes EXC
use with early CHF
can cause hypoNa

54
Q

With chronic hypoNa, do not exceed rate of correction of serum Na by more than_________.

A

8-12 in 24 hours

55
Q

Giving ____ while treating hypoNa with NaCl, helps avoid brain complications

A

furosemide

56
Q

Addison’s dz may require ____ replacement of Na.

A

slow

57
Q

What happens if you correct Na too fast?

A

Osmotic demyelination of brain

58
Q

Correct slow, if it occurs slow

A

Correct fast, if it occurs fast

59
Q

HyperNa

A

> 170 see problems

Hypertonic encephalopathy

60
Q

HyperNa main causes?

A

Na gain- uncommon

H2O loss - common (dehydration)

61
Q

HyperNa signs?

A 
fever
nausea, vomiting
seizures
coma
array of neuo signs
hypotension
tachycardia 
oliguria
62
Q

HyperNa types?

A

hypovolemic - renal/GI (v/d)
hypervolemic - due to hypertonic saline treatment
euvolemic - DI

63
Q

HyperNa treatment

A 
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
64
Q

ECC priorities?

A

Volume, pH, then electrolyte correction

Endocrinology - 2nd year (8 decks)

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