Calcium, Phosphate And Magnesium Flashcards

1
Q

What are the 2 ways of absorption of calcium and magenesium in the intestine

A

Paracellular

Transcellular

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2
Q

In the kidney where is calcium, phosphtate and magnesium absorbed more

A

Calcium: pct and dct
Phosphate: pct
Magnesium: dct

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3
Q

What are the causes of hypocalcaemia

A
Chronic and acute renal fialure
Vitamin d deficiency 
Hypo parathyroidism
Acute pancreatitis
Magnesium deficiency
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4
Q

What is the homesotasis of calcium and phosphate when there is low calcium

A
  1. Low calcium causes the release of PTH from the parathyroid gland
  2. PTH acts on the bone so calcium and phosphate is released
  3. There is also increased reabsorpion of calicum and decreased phosphate reabsorption in the kidney
  4. Pth acts on the kidney to stimulate the kidney to produce 1alpha OHase that converts 25OHD3 to 1,25OH2D3 ie vitamind D
  5. VitD acts on the bone to increase bone resorption so calcium is released
  6. Vitamind acts on the gut to cause calcium and phosphate absorption
  7. Vitamin d causes bone to regenerate FGF23 thaty causes decrease phosphate reabsorption so phosphate is secreted and calcium is corrected
  8. Vitamind d and corrected calcium sends a feedback to the parathyroid gland for negative feedback
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5
Q

What is the cause of rickets/osteomalacia

A

Vitamin d deficiency

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6
Q

What happens to the bone in osteomalacia/rickets

A

Lack of mineralisation of the bone due to failure of absorption of calcium from the GIT

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7
Q

What are the causes of vitamind deficiency

A

Imapired avaialblity of vitamind: lack of sunlight or fat malabsorptive state
Impaired liver hydroxyaltion
Impaired renal hydrocxyaltion to 1.25ohd
End organ insensitivity to vitamind metabolites

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8
Q

What is the treatment of osteomalacia/rickets

A

Vitamin d replacement

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9
Q

What happens when there is hypercalcaemia

A

Parathryoid gland causes a decrease in PTH
Bon resorption decreases
In the kidney: there is a decrease in phosphate excretion, increased calcium excretion. Reduced 1,25d3,
In the intestine: decreased calciuma and phosphatte absorption

All together this reduced serum calcium

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10
Q

What are the main causes of hypercalcaemia

A

Primary hyperparathyroidism - increased PTH

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11
Q

What are the 2 types of hyperparathyroidisim

A

Primary
Secondary
Tertiary

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12
Q

What is primary hyperparathyroidism

A

Increased PTH by adenoma, parathyroid hyperplasia and prathyroid carcinoma

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13
Q

What is secondary hyperparathyroidism

A

Due to:
Renal failure: failure of 1 hydroxylation
Vitamin d deficiency: failure to absorb calcium

Therefore PTH secretion increases

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14
Q

What is tertiary hyperparathyrodism

A

Prolonged secondary hyper parathyroidism

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15
Q

What are the symptoms of parathyroidism

A
Thirst, polyuria, constipation
Aches and pains
Lethargy and depression
Confusion
Renal stone, osteoporosis and pancreatitis
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16
Q

What is malignancy associated hypercalcaemia

A

Malignancy that causes hypercalcaemia

17
Q

What is the mechanism for malignancy associated hypercalcemia

A

bone invasion- causes resoption of calcium into the blood
Rare causes; drugs, immobilisation
Humoral hypercalcemia: PTH related or non PTH related

18
Q

What is the treatment for malignancy associated hypercalcaemia

A
19
Q

What are the causes of hypophosphatemia

A

Gi malabsorption
Renal loss
Intracellular shift e.g people on insulin

20
Q

What is the treatment for hypophosphatemia

A

Mild phosphate tablets- if mild

Iv phosphate replacement- if severe

21
Q

What are the causes of hyperphosphatemia

A

Decreased renal excretion

Hypo parathyroidism

22
Q

What are the causes of hypomagnesimia

A

Gastrointestinal disorders: alcohoilic and malabsorption disorder

23
Q

What are the symptoms of hypomagnesiima

A

Lethargy
Weakness
Increase in nuetromuscular excitability e.g tremor

24
Q

What features of hypomagnesimia and renal magnesium wasting

A

Gitelman syndrome

25
Q

What is gitelman syndrome caused by

A

Mutation in SLC12A3 genes that codes the sodium chloride co transoprter in the DCT in the kidney

26
Q

How is hypomagnesmia treated

A

Oral magnesium

Iv magnesium sulphate

27
Q

What are the causes of hypermagnesiim

A

AKI
Severe diabetic ketoacidosis
Addisons disease
Supplemetns

28
Q

What is the treatment for hypercalcaemia

A

Aggressive iv hydration
Calcitonin
Bisphosphonates
If volume overload- loop diuretic