Calcium Disorders

Question 1

What are the 2 main categories of hyperparathyroidism?

Answer 1

1. Primary

2. Secondary

Question 2

Primary hyperparathyroidism is typically caused by what?

Answer 2

Benign functional adenoma

Question 3

What are other causes of primary hyperparathyroidism?

Answer 3

Hyperplasia of parathyroid glands, parathyroid adenocarcinoma (badddd news bears, luckily rare)

Question 4

What would you expect iCa2+ to be like for primary hyperparathyroidism?

Answer 4

High

Question 5

What are 2 major causes of secondary hyperparathyroidism?

Answer 5

Nutritional and Renal

Question 6

What would you expect iCa2+ to be like for secondary hyperparathyroidism?

Answer 6

Low to normal

Question 7

Approximately how much iCa2+ is in the blood?

Answer 7

50%

Question 8

How much iCa2+ is protein bound in the blood?

Answer 8

40%

Question 9

If your total Ca2+ is low, what is one important thing to look at on your chemistry?

Answer 9

Is the Albumin also low? Since Ca2+ is protein bound, it is important to see if your Albumin is also decreased.

Question 10

PTH stands for what?

Answer 10

Parathyroid hormone

Question 11

Where does PTH come from and what is it’s purpose?

Answer 11

Parathyroid gland and to increase Ca2+ levels.

Question 12

What are some differentials for HYPERcalcemia?

Answer 12

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

Question 13

How can you calculate when an animal might start getting mineral deposition in soft tissues?

Answer 13

Take the Ca2+ x P from blood work and if the product is >70 you know this is bad news bears.

Question 14

What is the #1 clinical sign of hypercalcemia?

Answer 14

PU/PD

Question 15

Why do animals become PU/PD with hypercalcemia?

Answer 15

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.

Question 16

How would you treat an animal with hypercalcemia?

Answer 16

Saline diuresis, Furosemide (once properly hydrated), Calcitonin (if Vitamin D toxicity suspected), Bisphosphonates

Question 17

After repeating blood work to check to make sure the hypercalcemia wasn’t spurious, what is the next thing you’d wanna check?

Answer 17

iCa2+ (if normal then the increase in total Ca2+ is not significant).

Question 18

If after checking iCa2+ you notice there are increases, what would you do next?

Answer 18

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).

Question 19

What would hypocalcemia look like on an ECG?

Answer 19

Deep, wide T waves with a prolonged ST interval.

Question 20

What are the clinical signs associated with hypocalcemia?

Answer 20

Muscle fasiculations, tetany, seizures, panting

Question 21

How would you treat hypocalcemia?

Answer 21

Ca Gluconate IV slowly, monitor the ECG for arrhythmias and the temperature.

Question 22

What is the primary cause for primary hypoparathyroidism?

Answer 22

Idiopathic destruction of parathyroid gland, this is immune mediated.

Question 23

With primary hypoparathyroidism what would you expect the PTH to be?

Answer 23

Low

Question 24

With primary hypoparathyroidism what would you expect iCa2+ to be?

Answer 24

Low