Calcium Disorders Flashcards
What are the 2 main categories of hyperparathyroidism?
- Primary
2. Secondary
Primary hyperparathyroidism is typically caused by what?
Benign functional adenoma
What are other causes of primary hyperparathyroidism?
Hyperplasia of parathyroid glands, parathyroid adenocarcinoma (badddd news bears, luckily rare)
What would you expect iCa2+ to be like for primary hyperparathyroidism?
High
What are 2 major causes of secondary hyperparathyroidism?
Nutritional and Renal
What would you expect iCa2+ to be like for secondary hyperparathyroidism?
Low to normal
Approximately how much iCa2+ is in the blood?
50%
How much iCa2+ is protein bound in the blood?
40%
If your total Ca2+ is low, what is one important thing to look at on your chemistry?
Is the Albumin also low? Since Ca2+ is protein bound, it is important to see if your Albumin is also decreased.
PTH stands for what?
Parathyroid hormone
Where does PTH come from and what is it’s purpose?
Parathyroid gland and to increase Ca2+ levels.
What are some differentials for HYPERcalcemia?
Remember the acronym HARD IONS H- Hyperparathyroidism A-Addison's R- Renal Failure D- Hyper Vitaminosis D I- Idiopathic (seen in cats) O-Osteolysis N-Neoplasia S-Spurious
How can you calculate when an animal might start getting mineral deposition in soft tissues?
Take the Ca2+ x P from blood work and if the product is >70 you know this is bad news bears.
What is the #1 clinical sign of hypercalcemia?
PU/PD
Why do animals become PU/PD with hypercalcemia?
They develop nephrogenic Diabetes Insipidus. There is damage to kidneys and there is decreased sensitivity to ADH (Anti-Diuretic Hormone) acting at the collecting duct, therefore more water is released into urine.
How would you treat an animal with hypercalcemia?
Saline diuresis, Furosemide (once properly hydrated), Calcitonin (if Vitamin D toxicity suspected), Bisphosphonates
After repeating blood work to check to make sure the hypercalcemia wasn’t spurious, what is the next thing you’d wanna check?
iCa2+ (if normal then the increase in total Ca2+ is not significant).
If after checking iCa2+ you notice there are increases, what would you do next?
Ask a more thorough history to see if there has possibly been a Vitamin D toxicity, do a thorough cancer hunt (palpate mammary glands, perform a rectal exam, palpate lymph nodes.) Possibly do an FNA of lymph nodes. Screen the patient for renal disease of Addison’s (ACTH stim test).
What would hypocalcemia look like on an ECG?
Deep, wide T waves with a prolonged ST interval.
What are the clinical signs associated with hypocalcemia?
Muscle fasiculations, tetany, seizures, panting
How would you treat hypocalcemia?
Ca Gluconate IV slowly, monitor the ECG for arrhythmias and the temperature.
What is the primary cause for primary hypoparathyroidism?
Idiopathic destruction of parathyroid gland, this is immune mediated.
With primary hypoparathyroidism what would you expect the PTH to be?
Low
With primary hypoparathyroidism what would you expect iCa2+ to be?
Low
