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Endocrine Pathology > CP 52 - Disorder of Calcium, Phosphate & Magnesium > Flashcards

CP 52 - Disorder of Calcium, Phosphate & Magnesium Flashcards

1
Q

What chemical property does calcium have?

A

Divalent cation - Ca2+

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2
Q

why is calcium important physiologically?

A

Muscle contraction, neuronal excitation, enzyme activity (Na/K ATPase, hexokinase), Blood Clotting

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3
Q

Why is calcium structurally important?

A

key component of hydroxyapatite - Ca10(PO4)6(OH)2 - predominant mineral in bone

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4
Q

How is calcium used in blood clotting

A

calcium is being caught by anti-coagulant so can not be used for clotting.

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5
Q

What chemical property does phosphate has?

A

Monovalent anion - Po4-

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6
Q

why is phosphate important physiologically?

A

The P in ATP, intracellular signalling, cellular metabolic process eg glycolysis

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7
Q

Why is phosphate structurally important?

A

backbone of DNA, component of hydroxyapatite - ca10(PO4)6(OH)2, Membrane phosholipids

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8
Q

is phosphate intracellular/extracellular

A

intracellular

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9
Q

What chemical property does magnesium have?

A

Divalent Cation - Mg2+

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10
Q

why is magnesium important physiologically?

A

cofactor for ATP (important), neuromusclar excitability, enzymatic function, regulates ion channels

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11
Q

Why is magnesium structurally important?

A

comprises 0.5% -1& of bone matrix

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12
Q

which ion does alk phos rely on?

A

Zinc

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13
Q

what are the 4 things which are related to unbalanced homeostasis

A

intake from guts, storage in bone, excretion/loss from intestines & kidneys, tissue redistribution of ions

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14
Q

normal range of calcium?

A

2.20.2.60 mmol/L

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15
Q

what are the 2 controlling factors for calcium

A

PTH, Vit D and metabolites

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16
Q

what are the 3 complex reaction between calcium with?

A

GI uptake of Ca2+, Renal clearance & bone as storage

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17
Q

Total Ca = ?

A

Total Ca = ionised Ca + bound Ca+ complexed Ca

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18
Q

what is ionised ca

A

physiologically active fraction eg ca sensing receptor, cellular effects, regulation of PTH

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19
Q

what is bound ca?

A

physiologically inactive eg albumin main binding protein ~ 50%

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20
Q

what is complexed ca?

A

salts eg calcium phosphate & calcium citrate

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21
Q

what is routine measurement for Ca?

A

total calcium (but does not reflect ionised calciu)- cost effective & convenience

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22
Q

what factor affect Ca?

A

total Ca - by [albumin], ionised Ca - by pH

23
Q

what compete for albumin binding site with Ca?

A

H+ ions - acidosis - reduces Ca-albumin, Alalosis - increase Ca-albumin

24
Q

what disorders can affect ca conc?

A

PTH, Vit D, Bone Metastases, GI tract - malabsorption, kidney & diet

25
Q

what is the amount of Ca present in bone

A

25Mol - 99% of the whole body’s conc

26
Q

what is the role of oestrogen for ca absorption?

A

oestrogen stimulates Ca reabsorption in the kidney

27
Q

what does FGF23 stimulate?

A

it stimulate the phosphate excretion (by decreaseing phosphate reabsorption)

28
Q

Which UV light is absorbed to be used or Vit D production?

A

UV-B

29
Q

What form of Vit D is produced in the skin?

A

D3

30
Q

what enzyme convert D3 in the liver?

A

25-Hydroxylase

31
Q

What form of Vit D is produced in liver?

A

25(OH)D3

32
Q

where is 25(OH)D3 transported to after being produced in the liver?

A

kidney

33
Q

what form of Vit D is produced in the kidney?

A

1,25(OH)2D3

34
Q

which organ does PTH take effect to affect production of Vit D ?

A

Kidney

35
Q

what is the role of PTH have on production of Vit D?

A

PTH essential for production of Vit D as it convert the inactive form of Vit D - 25(OH)2 D3 into 1,25(OH)2D3

36
Q

what is the physiological function of 1,25(OH)2D3

A

essential for Ca and PO4 absorption, increase bone mineralisation, induces differentiation of immune cells, inhibts proliferation of tumor cells, induces differentiation of tumor , inhibits angiogenesis

37
Q

What does increase in 1,25(OH)2D3 do to your body?

A

decrease production of PTH

38
Q

what are the uses of PO4 & Ca to the kidney?

A

PO4 & Ca are correlated to the production of active form of Vit D

39
Q

what is calcium - PTH loop?

A

PTH - (+) - bone, gi & kidney (uptake & reabsorption) - Ca - (-) - PTH production.

40
Q

what are the relationship between Vit D and BMi

A

Vit D is hydrophobic & can deposit in the adipose tissue

41
Q

What are the causes of hypocalcaemia?

A

hypoproteinaemia, Vitamine D deficiency (dietary/malabsorption), hepatic disease, renal disease, diabetes, hypoparathyroidism (1o & 2o to mg depletion), pseudohypoparathyroidism (End organ PTH resistance)

42
Q

Causes of hypercalcaemia?

A

hyperparathyroidism, malignancy, drugs, vit D excess (1aplha cholecalciferol, sarcoidossi), bone disease+ immobilisation

43
Q

what is adjusted calcium?

A

Ca conc accounted for changes in albumin

44
Q

what is the formula for adjusted ca?

A

adj ca = total ca +(40- Alb)X0.025

45
Q

what does high Cac & PTh and low Pi indicate?

A

1o hyperparathyroidism

46
Q

what does high ca and low PTH indicate?

A

malignancy

47
Q

What are the causes of phosphate deficiency?

A

hyperparathyroidism, excess loss (renal tubular damage, GI loss, diabetes -diuresis), poor intake (malnutrition, inadquate IVN), ECF/ICF redistribution

48
Q

symptoms of phosphate deficiency?

A

Haemolysis, thrombocytopenia, ppor granulocyte function, severe muscle wakness, respiratory muscle failure, confusion, irrability and coma, renal dysfunction

49
Q

what is treatment of phosphate deficiency?

A

IV fluid including TPN (total parental nutrient) formulations

50
Q

What are hypomagnesaemia associated to?

A

hypokalaemia, hyponatraemia(Na+), hypophosataemi, hypocalcemia

51
Q

Causes ofMagnesium depletion?

A

renal disease, hypercalcaemic states, drugs eg diuretics,cisplatin(chemotherapty), antibiotics (gentamicin), GI tract malabsorption problems

52
Q

Effects of magnesium depletion

A

cellular - reduced mitochondrial respiration, impaired phosphrylation, defective NA-K ATPase activity, Biochemical - hypocalcaemia, hypophosphataemia, hypokalaemia, Endocrine - impaired PTH release, PTH resistance in bone, CVS - cardiac irritability, reduced contractility, CNS - hyperreflexia, tetany, Muscle - weakness, muscle fibrilliation

53
Q

what is good indication for Mg level in the body

A

leucocyte Mg - good correlation, good predictive value

Endocrine Pathology (5 decks)

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