Calcium/Phosphorus Flashcards
Normal: Serum Ca/Ph & Urine Ph/Ca
-Serum Ca: 8.5-10.5
-Serum Ph: NL
-Urine Ph: NL
-Urine Ca: NL
“What Hormones are associated with Increased Calcium”
-“PTH”: Quickly
-“Active D3”: Slower Acting
“What hormones are associated with decreased calcium”
-“Calcitonin”: Slow
Primary Hyperthyroidism
-Serum Ca
-Serum P
-Urine P
-Urine Ca
-Serum Ca: Increased
-Serum P: Decreased
-Urine P: Increased
-Urine Ca: Increased
Secondary Hypoparathyroidism
-Serum Ca
-Serum P
-Urine P
-Urine Ca
-Serum Ca: Decreased/Normal
-Serum P: Increased
-Urine P: Decreased
-Urine Ca: Increased
Tertiary Hyperparathyroidism
-Serum Ca
-Serum P
-Urine P
-Urine Ca
-Serum Ca: Increased
-Serum P: Increased
-Urine P: Decreased
-Urine Ca: Increased
When do we have a positive/negative calcium balance?
-Positive: Childhood for skeletal growth
-Negative: Old age/disease states (Calcium output > input)
Hormones involved in increasing plasma calcium
• Parathyroid hormone (PTH)
• 1,25 dihydroxycholecalciferol
Plasma calcium lowering hormone
Calcitonin: C-Cells in the thyroid gland
How does PTH act on bone?
Stimulates osteoclastic activity (release of CaPO4)
How does PTH act on the kidney?
- Excretion of phosphorus (decreased reabsorption)
- Reabsorption of Ca2+ in kidney
- Activation of D3
1,25 DHCC: Actions
Absorption of calcium from intestine
-Deposition & resorption of calcium salts in bone
-Direct PTH-like effects on renal tubule
Total Calcium: Normal limits
8.5-10.5mg/dL
MCC of hypercalcemia
Hyperparathyroidism
MCC of hypercalcemia
Hyperparathyroidism
Decreased Serum Calcium levels induced _______ secretion of PTH
Increased
Serum Calcium Testing is used to evalutate
Parathyroid function and calcium metabolism
Excess vitamin D ingestion can:
Increased Serum calcium by increasing GI & renal absorption
Intestinal malabsorption & renal failure is associated w/:
Low serum calcium
Plasma albumin levels ______ calcium
Parallel
Low pH = ______ ionized calcium
Increased
High pH = _____ ionized calcium
Decreased
Normal Calcium findings: Adult
*8.5-10.5 mg/dL
*Mneumonic for remembering hypercalcemia
“CHIMPS”
-Cancers
-Hyperthyroidism
-Iatrogenic
-Multiple Myeloma
-Primary Hyperparathyroidism
-Sarcoidosis
What bone diseases are associated with hypocalcemia?
Osteomalacia & Rickets
________ can bind phosphorus and decrease absorption
Antacids
There is a _____ relationship between calcium and phospohrus
Inverse*
Renal failure is associated with
Hyperphosphatemia
Vitamin D deficiency, Rickets and Osteomalacia are assocaited with:
Hypocalcemia & Hypophosphatemia
(Decreased Ca, Increased PTH, More phosphorus excreted in urine)
Hyperparathyroidism: PTH, Serum Calcium, Phosphorus Levels
-Increased PTH
-Increased Serum Calcium
-Decreased Phosphorus
Hypoparathyroidism: PTH, serum calcium, serum phosphate
-Decreased PTH
-Decreased Serum Calcium
-Increased Serum Phosphate
(ALP normal)
Most common cause of Hyperparathyroidism
Adenoma
Signs/Symptoms of Hypocalcemia
• Tetany
• Paresthesia: Early
• Convulsions: Later
• Neuromuscular irritability (muscular twitching) (Chvostek’s sign Trousseau’s test)
• Mental changes: Irritability & Psychosis
Hyperparathyroidism-Primary Findings
• Increased PTH
• Hypercalcemia
• Hypophosphatemia
• Increased ALP
• Increased serum vitamin D
• Hyperphosphaturia
• Hypercalciuria
“Stones” (Hypercalcemia)
Nephrolithiasis-Most frequent clinical manifest.
“Bones” (Hypercalcemia)
Metabolic bone disease-Osteoporosis, Fracture
“Psychiatric Overtones” (Hypercalcemia)
Depressed Nervous System-Fatigue, depression, confusion, coma
“Groans” (Hypercalcemia)
Peptic Ulcer & Constipation
Thrones” (Hypercalcemia)
Polyuria
MC Cause of Secondary Hyperthyroidism
Chronic Kidney Disease*
Lab Findings w/ CKD
• Increased PTH
• Hypocalcemia or normocalcemia*
• Hyperphosphatemia*
• Decreased serum vitamin D*
• Decreased phosphate in urine*
• Hypercalciuria
Tertiary Hyperparathyroidism is a progression of
Secondary hyperparathyroidism
Tertiary Hyperparathyroidism: Lab Findings
• Significant elevation of PTH*
• Hypercalcemia
• Hyperphosphatemia
Liver Disease: ____ BUN
Decreased
Kidney Disease: ____ BUN
Increased
BUN: Interfering Factors
• Changes in protein intake can alter BUN
• Over (decreased)/under (increased) hydration
• Certain drugs
Any cause of reduced renal blood flow or increased production of urea
Prerenal azotemia
Renal Azotemia
• Glomerulonephritis
• Pyelonephritis
• Acute tubular necrosis
• Nephrotoxic drugs
Any obstruction of the urinary tract
Post-renal azotemia
MCC of post-renal azotemia
Prostatic Hypertrophy
Decreased levels of BUN
• Severe liver damage
• Overhydration
• Malnutrition
Creatinine is elevated in all diseases of the ____ in which ___% or more of the nephrons are destroyed
Kidney; 50%
Creatinine: Critical values
• >4 mg/dL indicates serious impairment in renal function
(Shut down of kidneys)
Creatinine: Critical values
• >4 mg/dL indicates serious impairment in renal function
(Shut down of kidneys)
Rhabdomyolysis
-Breakdown of skeletal muscle & statins, exercise
-Causes fatigue, myalgia and dark urine (decreased urine output)
Elevations in Creatinine
-Creatine, increased muscle mass, exertion & dehydration
Decreased Levels of Creatinine
• Decreased muscle mass
-Overhydration
Decreased Levels of Creatinine
• Decreased muscle mass
-Overhydration
BUN: Creatinine Ratio
• Normal: 10:1
• Pre-renal disease: >10:1
• Renal disease: 10:1-Elevations of BUN/Creatinine (100:10)
• Post-renal disease: >10:1
• Nitrogenous compound that is a product of purine catabolism
Uric Acid
• Nitrogenous compound that is a product of purine catabolism
Uric Acid
MCC for hyperuricemia
Renal Disease
Uric Acid: Increased Levels
• Gout
• Hematologic conditions: Infections, PCV
• Malignancies
• Chronic renal disease
• Increased ingestion of purines
Uric Acid: Increased Levels
• Gout
• Hematologic conditions: Infections, PCV
• Malignancies
• Chronic renal disease
• Increased ingestion of purines
Uric Acid: Decreased Levels
• Aspirin
• Vitamin C
• Liver disease
