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Clinical Chemistry (me) > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

What are three sites that calcium is regulated?

A
  1. GI
  2. Bone
  3. Renal
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2
Q

How is calcium regulated in the kidney?

A

PTH increases reabsorption (tubular)
PTH increases vitamin D production
Calcitonin decreases reabsorption (tubular)

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3
Q

What three things influence general interpretation of total blood calcium?

A
  1. Calcium fractions (ionized, protein blound, complexed) - total calcium on biochem is assumed to represent ionized
  2. Protein influence
  3. pH influence
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4
Q

What does the biochemistry calcium measure? What is the term for this?

A

50% ionized
40% protein bound
10% complexed (citrates, phosphates)

Calcium fractions

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5
Q

What calcium fraction is biologically active?

A

Ionized calcium

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6
Q

T/F

Calcium is heavily regulated, tight to its reference range

A

True

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7
Q

What is the #1 cause for hypocalcemia? Does this alter the ionized Ca levels?

A

Hypoalbuminemia

No - not to worry!

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8
Q

What is the correction formula for albumin influence?

A

Total Ca - albumin + 3.5

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9
Q

How does pH influence calcium?

A

Calcium and hydrogen compete for binding sites on albumin. Increase or decrease hydrogen can have an affect on calcium

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10
Q

With acidemia, what will the calcium look like? Alkalemia?

A

acidemia – Hypercalcemia

alkalemia – Hypocalcemia

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11
Q

What would cause the masking of a pathologic change in Ca? When is this clinically most important

A

Protein value
Blood pH

with alkalemia

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12
Q

Could alkalemia alone cause clinical signs of hypoclacemia?

A

No

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13
Q

What is the most common cause for hypercalcemia?

A

Humoral Hypercalcemia of malignancy

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14
Q

What are causes for high hypercalcemia values?

A

HHM
Primary hyperparathyroidism
Vitamin D toxicity
Addison’s disease

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15
Q

What are causes for lesser elevations in calcium?

A

Very high value disease (early stage)
Renal failure
Various bony lesions (HOD, fungal)
+/- alkalemia (increase protein bound fraction)

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16
Q

What are causes for hypocalcemia?

A
  • may show symptoms to hypocalcemia (severe)
    1. Hypoproteinemia
    2. Equine colic (anorexia, decreased absorption)
    3. Renal failure
    4. Acute Pancreatitis (calcification)
    5. Hypomagnesemic (“Grass”) tetany
    6. Mercury toxicity
    7. *Milk Fever, eclampsia
    8. *Ethylene glycol toxicity
    9. *Hypoparathyroidism
    10. *Blister beetle toxicity
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17
Q

What are two HHM causes? Most common to least

A

Lymphosarcoma&raquo_space; anal sac adenocarcinoma

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18
Q

What is the mechanism for HHM?

A

stimulation of osteoclastic activity (PrPTH)

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19
Q

What is the most common change in calcium during primary renal azotemia? Mechanism?

A

Normocalcemia or mild hypocalcemia

Hypocalcemia secondary to effects of increased P and decreased vitamin D production

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20
Q

How do horse’s calcium values present during primary renal azotemia? Why?

A

Hypercalcemia
High Calcium diets
GI poorly regulates Calcium (normally kidney gets rid of excess Ca)
Renal azotemia –> decrease excretion of Ca –> horse continues to eat –> hypercalcemia

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21
Q

What is a common sign of persistant hypercalcemia?

A

PU/PD (hyperCa interferes with ADH activity on tubules), secondary to renal tubular damage

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22
Q

What does moderate-severe hypercalcemia with laboratory evidence of renal failure probably indicate?

A

Secondary renal involvement!!

Hypercalcemia INDUCED renal azotemia

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23
Q

What is a severe hypercalcemia value?

A

> 13-14

24
Q

What does hypercalcemia with metastatic calcification result in?

A

Tubular degeneration
Mineralization of BM’s
Interstitial fibrosis
Primary renal azotemia

25
Q

What are 5 causes for hyperphosphatemia?

A
  1. Renal (decrease GFR)
  2. Vitamin D toxicity
  3. Hypoparathyroidism (decreased PTH)
  4. Young animal (active BM 6 month - 1 year)
  5. Osteolytic bone lesions
26
Q

What does PTH do to Phosphorus at the level of the kidney?

A

PTH reduces phosphorus reabsorption

27
Q

What are causes for hypophosphatemia?

A
  1. HHM (renal azotemia may influence the P to elevate - depends)
  2. Hyperparathyroidism
  3. Anorexia, inadequate diet
  4. Diabetes mellitus (osmotic diuresis)
  5. Insulin therapy (drives P into cells)
  6. Bovine post-parturient hemoglobulinuria (uncommon, dairy cow on P deficient soil)
28
Q

What are the major mechanism categories for phosphorus shifts?

A

Renal excretion
Dietary intake
Hormonal influence
Transcellular shifts (insulin, possibly acid/base)

29
Q

What is the number one cause for shifts in phosphorus?

A

Renal excretion (decrease GFR)

30
Q

How does the glomerulus handle phosphorus? Tubules?

A 
Freely filtered
Tubular reabsorption (PTH decreases reabsorption)
31
Q

What is renal secondary hyperparathyroidism?

A

Hyperphosphatemia induced hypocalcemia

32
Q

What amount of the body’s magnesium is in the blood?

A

1%

the rest is in soft tissue and bone @ 50:50

33
Q

T/F

Mg is tightly regulated

A

False

Mg is slowly corrected – equilibrium b/w pools is reached slowly

34
Q

What primarily controls serum levels of Mg?

A

renal excretion

35
Q

How can Mg affect calcium levels?

A

Mg is needed for PTH release!

36
Q

What can cause hypomagnesemia?

A
  1. Milk tetany - all milk diet, low in Mg
  2. Grass tetany - adults, lush pastures, possibly after poor winter diet
    High K interferes with Mg absorption
37
Q

What is an important differential dx with sudden death syndrome?

A

Grass tetany

38
Q

What could cause Mg to falsely elevate from low levels back to normal?

A

Muscle activity (Collect samples early!)

39
Q

What is a good post mortem dx for hypomagnesemia?

A

urine concentration of Mg

40
Q

Common causes of hypernatremia related to dehydration.

A
  1. Insensible water loss: fever, panting, restricted access
  2. GI loss: most vomiting, some diarrhea
  3. Renal failure (dependent on dehydration state)
  4. Diabetes insipidus (central or renal): mainly if water is restricted
41
Q

Common mechanisms for hyponatremia

A
  1. Loss: GI, Renal

2. Redistribution: Third space disease, intravascular dilution (osmotic)

42
Q

What are some causes for hyponatremia?

A

GI loss

  1. Diarrhea
  2. Saliva (horse)

Renal loss

  1. Renal failure (severe losses in bovine)
  2. Hypoadrenocorticism (Addison’s)
  3. . Osmotic diuresis (DM)

Redistribution

  1. Ascites/edema
  2. GI obstruction/sequestration
  3. Hyperglycemia (DM)
43
Q

What is the Na value when we get concerned about medullary washout?

A

Na < 120

44
Q

What would be normal to see in bovine renal failure and sodium?

A

severe hyponatremia – they have greater Na loss

45
Q

What are 3 main mechanisms for potassium changes?

A
  1. Excretion (renal)
  2. Intake (GI)
  3. Internal shifts - redistribution (pH, insulin)
46
Q

How is potassium handled by the glomerulus? Tubules?

A

Glomerulus - freely filtered
Tubules
- 100% reabsorbed by PCT
- secretion of K at distal tubuels for urinary losses

47
Q

How does anuria, oliguria, and obstructive disease lead to marked hyperkalemia?

A

Decreased GFR
Decreased secretion
Associated acidemia

48
Q

How does hypoaldosteronism lead to hyperkalemia?

A

Aldosterone normally retains sodium and excretes potassium. Now potassium remains and sodium is excreted.

49
Q

When is chronic hyperkalemia associated with animals, especially cats?

A

Polyuric conditions

High output diseases like DM can cause this –> increase flow rate –> increase K losses (less time to reabsorb)

50
Q

What dietary situations can cause hypokalemia?

A
  1. Anorexia (expecially herbivores and cats)

2. GI disease (gastric vomiting) - probably from loss through kidney while trying to regain H+

51
Q

What are 3 major mechanisms for potassium changes?

A
  1. Renal
  2. GI/intake
  3. Internal shifts
52
Q

What are some internal shifts that would cause change in potassium change?

A
  1. Acidemia
  2. Alkalemia
  3. Insulin
  4. Hemolysis
53
Q

What is the difference b/w potassium levels in carnivores vs. herbivores? What species?

A

Herbivores > carnivores

- Horse, cow (mixed)

54
Q

What happens to muscles with severe hypokalemia? What is this called?

A

Leads to muscular weakness and eventually rhabdomyolysis (myoglobinuria and increased CK)
Hypokalemic polymyopathy

55
Q

What is a specific syndrome seen in older cats associated with renal disease/CRF? What are contributing factors?

A

Hypokalemic polymyopathy

  1. Increased renal loss (polyuria)
  2. Decreased overall food intake
  3. +/- Marginal dietary K content (food companies have mostly resolved this)
56
Q

What do cats with hypokalemic polymyopathy commonly present as?

A

present with weakness –> +/- cervical ventroflexion

57
Q

What genetic condition in Quarter Horses is related to an electrolyte disturbance? What is seen?

A

Hyperkalemic Periodic Paralysis
Skeletal muscle sodium channel gene
Transiently high K –> bradycardia

Clinical Chemistry (me) (4 decks)

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