isotonic saline for volume repletion, - loop diuretics if pt is hypervolemic after volume repletion - bisphosphonates in severy hyperca

Disorders of Calciume and phosphorus and Mg Flashcards by Bethany Eaton

what are the mechanisms for calcium and phosphorus maintained by?

Vit D, the small intestine, renal tubles, PTH, and bone

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what cells secrete PTH in the PT?

Chief Cells

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what does PTH do to the bone?

stimulates osteoclasts and osteoblasts (bone resorbed and Ca released into blood stream)

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renal actions of PTH?

increases reabsorption of Ca

passively in the proximal tubule
actively transported in cortical TAL of LOH and DCT

2) Inhibits reabsorption of phosphate: Occurs in the proximal tubule
3) Synthesis of calcitriol: Stimulates synthesis of 1-alpha hydroxylase to convert calcidiol to calcitriol

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Intestinal Actions of PTH?

ntestinal Actions

Increases the intestinal absorption of calcium by calcitriol

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what does increased levls of PTH cause?

increased serum calcium and decreased Ph

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what does decreased levels of PTH cause?

decreased serum Ca and increased Ph

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what are he most common causes of disorders of Ca and phosphorus?

parathyroid disorders, renal failure, malignancy

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what is one of the most common disorders of calcium and phosphorus in hospitalized pts w/ malignancies?

hypercalcemia

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what tpes of maligancies might pts get hypercalcemia w/

lung cancer, SCC of head, neck, and esophagus, femal genital tract carcinoma, multiple myeloma, lymphoma, renal cell carcinoam

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what are some other causes of hyperca

vit D intoxication
hyperparathyroidims
sarcoidosis

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CF of hyperca

anorexia, N, constipation, polyuria, polydipsia, dehydration, change in levelof consciousness

-volume depletion: orthostatic hypotension, tachycardia

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what dx studies need to be done in a hyper cc workup

corrected calcium (albumin)

CXR: pulmonary mass
UA for hematuria (early sign of RCC)
ESR: monoclonal gammopathy
vita D
24 hours urine collection

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what does an elevated urine clacium suggest?

malignant neoplastic or paraneoplastic process or hyperparathyroidims

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what does an decreased uring Ca suggest?

primary hyperparathyroidms

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tx of hyperCa

isotonic saline for volume repletion,

loop diuretics if pt is hypervolemic after volume repletion
bisphosphonates in severy hyperca

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what is the more common disorder? hyper Ca or hypoCa?

hypoCa!

critically ill ps

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what does hypoCa commonly result from

CKD or hypoparathyroidism

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what can sever hyopcalcemia cause?

compmelete cardiovascular collaps

what are clinical features of hypocalemia?

dry skin, brittle nails, pruritis, muscle cramping, SOB, numbness and tinglin in the extremeites

what are some sever cardiovasuble manifestation of hypoca

syncope and angina

what are some dlinical signs of hypocalcemia?

psroiasis, dry skin, perioral numbness,

-wheezing, bradycardia, crackles, 3rd heart sound

what are classic neurologic findings in hyopca?

trousseau sign, chvostek sign (facial nerve),

irritabilyt, confusion, dementaion, sz

what dx studies need to be done?

Ca < 8.5

ionized Ca, Mg, Ph albumine, LFts,

BUN and creatinine

tx of hypocalemia

tx any emergent CV states | -severe hypoca; I V calcium gluconate or Ca Cl

hyperphosatemia is most common secondary to what disorder?

CKD or excessiv euse of phosphate-containing laxitives or enemas

what is hypophosphatemia secondary to?

deminished supply or absorption, increased urinary loss, -vit D deviciency, -respiratory alkalosis burns -hyperparathyroidism

how is hypoPh classifed?

based on serum level - moderate: 1-2.5 and is usually ax - severe: 1 or less

what can severe hypoPh lead to?

rhabdomyolysis, paresthesia, encephalopathy

tx of hyperphopahtemia

if secondary to CKD- dietary phophorous restriction and oral phosphate binders -calcium carb tablest

hypomagensemia

denfined as plasma Mg levels of les than 1.8 mEq/L *plasma levels do not reflect total storage

when does hypoMg usually prsent?

when totat body stors are severly depleted- results from diminished intake and imparied absorbtion

what are some common causes of hypoMg?

chronic alcoholism, chronic D, hypopartathyroidism, hyperaldosteronis, diuretic therapy, osmotic diureses, and nutritional deficiencies

what OTC drug can cause hypomg?

PPI (greater than 5 yrs)

what are clinical features of hypomag?

lethargy, anorexia, N, V, wkns, tetany, seizure

what lab test should be checked along side HyopMg?

K, Ca, urine calcium | hypoaK, hyopCa, and hypocalciuria sheen w.hypoMg

what might an EKG show with hypoMg?

polonged PR and QT intervals, or widening of the QRS

how do you tx hypomg?

oral mg oxide in severe- Mg sulfate solution via IV, can used IM

hyper mg?

>2.2 | Mg stored in bones and muscles

CFof hypermg

sx are rare- except in pts w/ CKD who are given Mg containing products such as laxatives or antacids

what conditions can iatrogenically induce hypermg?

eclampsia or preterm labor

what are sgns and symptoms of hyperMg?

impaired neruomuscular transmission - reduced deep tendon reflexes - muscle weaknessm hypotenson - respiratory depression- cardiac arrest - N,V, flusing

what may been seen on an EKG w/ hypermg?

widened QRs, prolonged PR, prolonged QT

lab studies of hypermg?

bleeding and clotting times are incraeased

tx of hypermg?

calcium gluconate IV =saline diuresis and IV furosemide -dialysis