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Chemical Pathology > Calcium Control > Flashcards

Calcium Control Flashcards

1
Q

What is the normal range for calcium in the plasma?

A

2.2 to 2.6 mmol/L

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2
Q

What proportion of the calcium in the blood is free?

A

45%

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3
Q

What proportion of the plasma calcium is bound to albumin?

A

50%

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4
Q

What two hormones are involved in calcium metabolism?

A

PTH

  • increased tubular hydroxylation of vitamin D
  • Mobilises calcium from bone
  • Increase renal calcium resorption
  • Increased renal phosphate excretion

Calcitriol

  • Increased calcium and renal absorption from the gut
  • Bone remodelling
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5
Q

How does vitamin D get activated?

A

D3 in the skin goes to the liver, where it is converted into 25(OH)D3 by 25 hydroxylase. It then is transported to the kidney where it is converted into 1,25(OH)2D3 by 1 alphahydroxylase. This is the active form of vitamin D.

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6
Q

Name causes of hypocalcaemia

A
  • Hypoalbuminaemia
  • Chronis kidney disease
  • Hypomagnesaemia
  • Osteomalacia/ricket’s
  • Acute pancreatitis
  • Overhydration
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7
Q

What are the symptoms of hypocalcaemia?

A
  • Perioral parasthesia
  • Carpopedal spasm
  • Neuromuscular excitability
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8
Q

How is hypocalcaemia treated?

A
  • Give calcium if mild
  • Chronic kidney disease: alfacalcidol
  • Severe: 10% calcium gluconate IV
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9
Q

What are the symptoms of vitamin D deficiency?

A

Adults:

  • Bone or muscle pain
  • Increased risk of fractures

Children:

  • Bowing of the long bones
  • Myopathy
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10
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in primary hyperparathyroidism?

A 
Calcium: high
Phosphate: low
PTH: high
Alkaline Phosphatase: high
Vitamin D: normal
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11
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in secondary hyperparathyroidism?

A 
Calcium: low
Phosphate: high
PTH: high
Alkaline Phosphatase: high
Vitamin D: normal
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12
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in tertiary hyperparathyroidism?

A 
Calcium: high
Phosphate: low
PTH: high
Alkaline Phosphatase: high
Vitamin D: normal
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13
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in hypoparathyroidism?

A 
Calcium: low
Phosphate: high
PTH: low
Alkaline Phosphatase: low
Vitamin D: normal
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14
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in osteomalacia/ricket’s?

A 
Calcium: low
Phosphate: low
PTH: high
Alkaline Phosphatase: high
Vitamin D: low
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15
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in Paget’s disease?

A 
Calcium: normal
Phosphate: normal
PTH: normal
Alkaline Phosphatase: high
Vitamin D: normal
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16
Q

What are the expected levels (relative to normal) of Ca, PO4, PTH, AlkPhos and VitD in osteoporosis?

A 
Calcium: normal
Phosphate: normal
PTH: normal
Alkaline Phosphatase: normal
Vitamin D: normal
17
Q

What are the symptoms of hypercalcaemia?

A
  • Polyuria and polydipsia
  • Renal stones
  • Bone pain
  • Psychiatric disturbances
  • Abdominal pain
  • Muscle weakness
18
Q

Name some causes of hypercalcaemia

A
  • Dehydration
  • Primary hyperparathyroidism
  • Tertiary hyperparathyroidism
  • Malignancy
  • Excess vitamin D
  • Sarcoidosis
  • Thyrotoxicosis
19
Q

How is hypercalcaemia treated?

A
  • Fluids
  • Fluids
  • Fluids
  • Correct cause
  • Malignancy pts will get bisphosphonates to help with bone pain

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