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Endocrine > Calcium Disorders in Small Animals > Flashcards

Calcium Disorders in Small Animals Flashcards

1
Q

What processes does calcium play a pivotal role in?

A

Nerve conduction and neuromuscular transmission

Muscle contraction

Intracellular messenger involved in any number of cell signalling pathways

Coagulation

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2
Q

What are the two main pools of calcium?

A

Bone

Extracellular fluid

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3
Q

In what form is the calcium in bone present in?

A

Calcium hydroxyapatite

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4
Q

In what form is the calcium in extracellular fluid in?

A

Calcium bound to albumin
Calcium chelated to various compounds
Ionised calcium

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5
Q

Describe the uptake, storage and excretion of calcium..

A

Uptake = GIT
Required normal GIT function
Calcium actively absorbed from diet

Stored in skeleton
Mobilised by osteocalasts - Ca and PO4 released (precipitates as CaPO4)

Urinary excretion
Phosphate also excreted

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6
Q

What is calcium strictly controlled by?

A

Parathyroid hormone

Metabolites of Vit D (calcitriol)

Calcitonin

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7
Q

Describe how PTH controls calcium levels…

A

Increased in calcium via kidney:

  • Increased Ca resorption
  • Converstion of 25D3 to 1,25D3 (more biologically active)

Increases calcium via bones:
Activation of osteoclast activity

Increases calcium via GIT:
Enchanced absorbtion

Increases urinary phosphate excretion

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8
Q

What would happen to calcium and phosphate if you had too much PTH?

A

Calcium increases

Phosphate decreases

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9
Q

What are the actions of calcitriol?

A 
Increases serum calcium:
Increases GI absorption
Facilitates renal resorption
Mobilising Ca and PO4 from bone
-ve feedback on own secretion
Maintaining immune function
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10
Q

What would happen to calcium and phosphate if you had too much calcitriol?

A

Both calcium and phosphate would increase

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11
Q

How can you measure serum calcium?

A

Interested in ionised Ca
When you look at Ca always look at albumin
Ionised Ca prone to collection artefacts –> increased pH increases protein binding

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12
Q

Because CaPO4 is insoluble what needs to happen for an increase in ionised Ca when it is mobilised from bone?

A

PO4 has to be readily removed - otherwise will precipitate.

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13
Q

What needs to happen for disturbances in calcium balance to occur?

A

Disruption in:

  1. Hormonal control of calcium
  2. Organs involved in absorption, storage or excretion of calcium
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14
Q

What may disruption in calcium metabolism lead to?

A

Hyper/hypocalcaemia is problem with hormones/excretion/resorption

Altered bone metabolism without changes to serum calcium if nutritional secondary hyperparathyroidism

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15
Q

How can all raw meat diets be an issue for calcium?

A

Calcium to phosporus ration 1:50 in raw meat diet
Desired ration 1.2:1
Chronic resorption of bone to keep Ca normal
PTH very high

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16
Q

Why is calcium phosphate important?

A

High calcium phosphate = precipitation and deposition in tissues, esp kidneys

DEATH

17
Q

What are the clinical signs of hypercalcaemia?

A 
PUPD
Weakness, lethargy, depression
Inappetence, vomiting, diarrhoea, constipation
Facial pruritis and oral discomfort
Muscle twitching and fasciculations
Cardiac tachydysrhythmias
Sudden death

OR NO CLINICAL SIGNS

18
Q

What may you see on clinical pathology with hypercalcaemia?

A

Hypercalcaemia
With or without disruption to serum phosphate
With or without disruption to renal function

19
Q

What effects on renal function does hypercalcaemia have?

A

Interferes with tubular function = trouble concentrating urine

  • Dog USG <1.035
  • Cat USG <1.040
  • Stops absorption of Na in thin ascending limb and reduces tissues sensitivity (medullary hypertonicity)

Vasoconstriction of afferent glomerular arteriole
Azotemia

Structural renal disease
CaPO4 precipitate

20
Q

Is hypercalcaemia due to renal function if:

a. Low or normal phosphate
b. High phosphate

A

a. Cannot be due to renal dysfunction

b. Either renal dysfunction or structural renal disease due to CaPO4

21
Q

What are the reasons for hypercalaemia?

A

Non-pathological
Rapidly growing dogs
Lab error

Transient
Haemoconcentration (dehydration)
Hyperalbuminaemia

Pathological
Increased PTH/PTH-like activity
Unrelated to increased PTH activity

22
Q

What can cause hypercalcaemia due to increase PTH activity?

A

Primary hyperparathryoidism

23
Q

What can cause hypercalcaemia due to increased PTH-like activity?

A

Paraneoplastic effect

Lymphoma, anal sac adenocarcinoma, pultiple myelomas

24
Q

If you have high calcium, should PTH be high or low?

A

LOW

If you have hypercalcaemia and PTH is normal, the PTH is too high.

25
Q

What are the causes of hypercalcaemia not related to PTH/PTH-like activity?

A

Vitamin D toxicity
Excessive supplementation
Rodenticides
Psoriasis cream

Granulomatous inflammation

Hypoadrenocorticism

Chronic kidney disease

Grape intoxications

Idiopathic

Significant osteolysis

26
Q

Which breed is over-representated in hyperparathryoidism?

A

Keeshunds

27
Q

What is the typical presentation of primary hyperparathryoidism?

A

Often well - hypercal incidental finding

Unremarkable PE

May develop urolithiasis

Hypercalcaemia usually has CS so if not thinking primary hyperparathyroidism

28
Q

What would the calcium clinical pathology look like for most animals with azotemic chronic kidney disease? Exceptions?

A

Serum calcium in ref range
Exceptioms where some are hypercal and hyperphos
NOT secondary renal hyperparathryoidism as they always have normal calcium

29
Q

Describe idiopathic hypercalaemia..

A

Most common cause in middle aged cats

Calcium oxalate uroliths

30
Q

What is the management for hypercalcaemia?

A 
Correct underlying cause
Reduce degree of hypercalcaemia:
Fluid therapy
Frusemide
Biphosphonates
31
Q

What is hypocalcaemia not an uncommon finding of?

A

Clinically insignificant result of hypoalbuminaemia

32
Q

What is the most frequent cause of hypocalcaemia?

A 
Chronic renal failure
Sometimes:
Pancreatitis
Hypoparathyroidism
Iatrogenic hypoparathyroidism
Eclampsia
33
Q

What are the clinical signs of hypocalcaemia in the small animal?

A 
Abnormal neuro, neuromuscular and GI function
Panting, anxiety, behavioural changes
Weakness with stilted stiff gait
Inappetence and vomiting
Hyperthermia
Muscle tremors and cramps
34
Q

What is the management of hypocalcaemia?

A

Correct underlying cause
Acute IV 10% calcium gluconate
Subacutely oral medication of calcitriol

35
Q

What are the most common causes of hypercalcaemia in cats?

A

Chronic kidney disease

Idiopathic

36
Q

What are the most common causes of hypercalcaemia in dogs?

A

Neoplasia

Primary hyperparathryoidism

Endocrine (10 decks)

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