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[Lecture] CC II > Electrolytes: Part 2 (Calcium & Phosphate) > Flashcards

Electrolytes: Part 2 (Calcium & Phosphate) Flashcards

1
Q

Most abundant cation in the body

A

Calcium

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2
Q

Calcium is present almost exclusively in ______ (____________________________)

A

plasma
(Extracellular Fluid Ca2+)

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3
Q

Distribution

___ - Bones
___ - Blood (plasma) and other ECF

A

99%
1%

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4
Q

Blood Ca2+ (intravascular) is
______________ higher than other ECF
(interstitial)

A

5,000-10,000

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5
Q

Absorption:__________ (________)

A

duodenum
acidic pH

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6
Q

Enumerate the functions of Calcium

A
  1. Blood coagulation (especially ionized Ca2+ ),
    enzyme activity
  2. Skeletal and Cardiac muscle excitability
  3. Maintenance of Blood pressure
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7
Q

Forms of Calcium

A
  1. Ionized Calcium/Free Calcium
  2. Protein-bound Calcium
  3. Complexed with anions
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8
Q

How many percent is Ionized Calcium/Free Calcium?

A

50%

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9
Q

How many percent is Protein-bound Calcium

A

40%

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10
Q

How many percent is Complexed with anions?

A

10%

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11
Q

Sensitive and specific marker for calcium
disorders

A

Ionized Calcium/Free Calcium

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12
Q

Ionized Calcium/Free Calcium is not effected by ________ level

A

Albumin

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13
Q

T/F: Ionized Calcium/Free Calcium is pH independent

A

FALSE; pH dependent

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14
Q

________ pH: Ca2+ will be displaced from
albumin ((high/low)) free Ca2+)

A

Acidic
high

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15
Q

_________ pH: Ca2+ binds with albumin ((high/low))
free Ca2+)

A

Alkaline
low

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16
Q

Most active form and most abundant

A

Ionized Calcium/Free Calcium

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17
Q

Freely circulating calcium:

A

Ionized Calcium/Free Calcium

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18
Q

T/F: Ionized Calcium/Free Calcium is NOT bound to any substances

A

T

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19
Q

T/F: Ionized Calcium/Free Calcium circulates as calcium itself

A

T

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20
Q

Bound to _________; therefore, affected by __________
levels

A

Protein-bound Calcium
albumin

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21
Q

↓Albumin = (low/high) Protein + Ca2+ affecting total Ca2+

A

low

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22
Q

2nd most abundant

A

Protein-bound Calcium (40%)

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23
Q

Example of Complexed with anions

A

● HCO3-, citrate, lactate

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24
Q

Among the forms of calcium, only the __________ and _________________ are measured

A

Total Calcium
Ionized Calcium

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25
Q

Total Ca2+ = ___________ + Protein-bound +
Complexed with Anions

A

Ionized

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26
Q

only measures itself

A

Ionized Ca2+

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27
Q

REGULATION of Calcium

A
  1. Hypercalcemic
  2. Hypocalcemic
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28
Q

subs. that can ↑ Ca2+ levels

A

Hypercalcemic

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29
Q

enumerate the hypercalcemic substances

A

A. 1,25-Dihydroxycholecalciferol [1,25-(OH)2-D3]
B. Parathyroid Hormone (PTH)

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30
Q

1,25-Dihydroxycholecalciferol increases the _____________________, _________________ of Ca2+

A

intestinal absorption
renal reabsorption

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31
Q

Increased mobilization of Ca2+ from bones by
promoting bone __________ process.

A

1,25-Dihydroxycholecalciferol [1,25-(OH)2-D3]
resorption

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32
Q

Secreted by parathyroid gland

A

Parathyroid Hormone

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33
Q

Conserved Ca2+ by increasing ____________

A

Parathyroid Hormone
renal reabsorption

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34
Q

Increases level by mobilizing bone Ca2+

A

Parathyroid Hormone

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35
Q

How does Parathyroid Hormone increases level by mobilizing bone Ca2+

A

By activating bone resorption process

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36
Q

PTH activates ___________ (bone
macrophage) which destroys bone
tissues in which ____ of Ca2+ are found.
Therefore, it will liberate Ca2+ = (inc/dec) Ca2+

A

osteoclasts
99%
icn

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37
Q

Suppresses urinary loss of Ca2+

A

Parathyroid Hormone

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38
Q

Stimulates activation of inactive Vit. D
(______________) to active Vit. D3 (________)

A

Parathyroid Hormone
cholecalciferol
kidneys

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39
Q

Activation through the process of
______________ (addition of OH- in the liver on
the ____________ position) =_____________________
○ still inactive

A

hydroxylation
25th
25-hydroxycholecalciferol

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40
Q

Next hydroxylation happens in the ___________ on
the ______________ =
1,25-Dihydroxycholecalciferol (______________)

A

kidney
1st position
activated Vit. D3

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41
Q

subs. that can ↓ Ca2+ levels

A

Hypocalcemic

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42
Q

Enumerate hypocalcemic substance

A

A. Calcitonin

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43
Q

Secreted by the ____________________ of thyroid
glands

A

Calcitonin
parafollicular C cells

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44
Q

Inhibitor of ____ and ______

A

PTH
Vit. D3

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45
Q

Inhibits bone resorption

A

Calcitonin

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46
Q

bone destruction by osteoclast

A

bone resorption

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47
Q

Promotes urinary excretion of Ca2+

A

Calcitonin

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48
Q

Symptoms are usually neuromuscular excitability
(represent as tetany)

A

HYPOCALCEMIA

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49
Q

tetany is represented by:

A

muscle spasms,
paresthesia

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50
Q

What is pamamanhid

A

Paresthesia

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51
Q

HYPOCALCEMIA Only occurs: If Total Ca2+ _____ mmol/L (____mg/dL)

A

<1.88
<7.5

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52
Q

HYPOCALCEMIA 2 signs

A

Chvostek’s Sign
Trousseau’s Sign

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53
Q

contraction of facial
muscles in response to tap

A

Chvostek’s Sign

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54
Q

uses BP cuff

A

Trousseau’s Sign

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55
Q

BP cuff (inflated at _________ above the patient’s ____________ for 3-5 minutes)

A

20 mmHg
systolic

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56
Q

Trousseau’s sign

Shows ______/___________ spasm

A

carpal/Carpopedal

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57
Q

Causes of Hypocalcemia

A

● Hypoparathyroidism
● Vitamin D deficiency
● Malabsorption
● Alkalosis
● Acute pancreatitis
● Hypomagnesemia
● Hypermagnesemia
● Hypoalbuminemia

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58
Q

hypercalcemic

A

Hypoparathyroidism

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59
Q

hypercalcemia

A

Vitamin D deficiency

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60
Q

alkaline in the blood; the calcium will
(bind/lyse) to albumin

A

Alkalosis
bind

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61
Q

In Alkalosis

(low/high) Ionized Ca2+
(low/high)Total Ca2+

A

low
high

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62
Q

_____ (secreted by pancreas) will enhance
intestinal binding of Ca2+

A

Acute pancreatitis
Lipase

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63
Q

↓Mg2+

A

Hypomagnesemia

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64
Q

Inhibits parathyroid hormone (PTH) secretion

A

Hypomagnesemia

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65
Q

Impairment of parathyroid hormone action

A

Hypomagnesemia

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66
Q

Vitamin __ resistance

A

Hypomagnesemia
D

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67
Q

↑Mg2+

A

Hypermagnesemia

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68
Q

Inhibits parathyroid hormone secretion

A

Hypermagnesemia

69
Q

↓Albumin

A

Hypoalbuminemia

70
Q

T/F: Hypoalbuminemia/ Ionized calcium is not affected. Only affects total calcium.

71
Q

For every ↓1 g/dL ALB = ↓___mmol/L TC or
___ mg/dL TC

72
Q

Causes of Hypercalcemia

A

● Hyperparathyroidism
● Hyperthyroidism
● Benign Familial Hypocalciuria
● Malignancy
● Acidosis
● Increased Vitamin D
● Thiazide diuretics
● Prolonged immobilization

73
Q

main cause of hypercalcemia

A

Hyperparathyroidism

74
Q

PTH excess

A

Hyperparathyroidism

75
Q

mainly affect ionized Ca+ levels

A

Hyperparathyroidism

76
Q

can also affect parathyroid glands because
of ______________

A

Hyperthyroidism
proximity

77
Q

___________ does not have Ca+ (remains in the
blood)

A

Benign Familial Hypocalciuria
Urine

78
Q

↑Ca+ (separates/adhere) with albumin

A

Acidosis
separates

79
Q

↑ionized Ca+ , (inc/dec) total Ca+

A

Acidosis
↓

80
Q

↑bone resorption

A

Prolonged immobilization

81
Q

Specimun used in the laboratory analysis of Calcium

A

Serum
Heparinzed plasma
Timed urine sample

82
Q

What type of heparinized plasma is acceptable in Calcium laboratory analysis

A

Lithium heparin

83
Q

Never use EDTA or oxalates as they
__________ causing false decrease

A

chelate Ca2+

84
Q

Timed-urine sample must be __________

A

must be acidified

85
Q

How to acidify urine sample:

Addition of ________ of ___________ per
________ of urine

A

1mL
6 mol/L HCl
100 mL

86
Q

Considerations/Variables for Ionized Ca2+:

A
  1. Sample must be collected anaerobically
    (must not be exposed to air)
  2. Use dry heparin anticoagulant (if plasma)
87
Q

air exposure of blood causes the
release of _____

88
Q

_______ blood = Ca2+ binds with
___________ = false (inc/dec) in ionized calcium

A

alkaline
albumin
↓

89
Q

Alternative in Laboratory Analysis of Calcium Considerations

A

Serum tubes collected using
ETS

90
Q

Clotted and centrifuge for ___ minutes
at RT

91
Q

Laboratory methods for Calcium

A

A. Precipitation and Redox Titration
B. Ortho-Cresolpthalein Complexone Dyes
C. EDTA Titration Method
D. Ion Selective Electrode
E. Atomic Absorption Spectrophotometry
F. Flame Emission Photometry

92
Q

2 types of Precipitation and Redox Titration

A
  1. Clark Collip Precipitation
  2. Ferro Ham Chloranilic Acid Precipitation
93
Q

Clark Collip Precipitation End Product:

A

Oxalic acid

94
Q

Clark Collip Precipitation End Product color:

A

Purple color

95
Q

Ferro Ham Chloranilic Acid Precipitation end product:

A

Chloranilic acid

96
Q

Ferro Ham Chloranilic Acid Precipitation end product end color

A

Purple color

97
Q

Colorimetric method

A

Ortho-Cresolpthalein Complexone Dyes

98
Q

Interference of Ortho-Cresolpthalein Complexone Dyes

99
Q

the interference Mg2+ causes false (inc/dec)

100
Q

Mg2+ inhibitor/chelators is added
(__________________)

A

8-hydroxyquinoline

101
Q

Dye in Ortho-Cresolpthalein Complexone Dyes

A

Arzeno III

102
Q

EDTA Titration Method example

A

Bachara, Dawer and Sobel

103
Q

Liquid membrane

A

Ion Selective Electrode

104
Q

reference method for calcium

A

Atomic Absorption Spectrophotometry

105
Q

Almost all phosphorus are combined with O2
forming __________

106
Q

Predominant intracellular anion

107
Q

● PO4 is inversely related to _______

108
Q

Phosphate distribution

→ ____ - bones
→ ____- soft tissues
→ ____ - plasma

109
Q

Adsorption in phosphates

A

Jejunum (in diet)

110
Q

Function of Phosphates

A

→ Insulin-mediated glucose entry in the cell
→ DNA and RNA structures
→ Energy reservoir
→ Promotes hemoglobin affinity to oxygen
→ Coenzyme

111
Q

Process present in Insulin-mediated glucose entry in the cell

A

phosphorylation

112
Q

Phosphates present in DNA and RNA structures

A

phosphodiesters

113
Q

Phosphates present in Energy reservoir

A

Adenosine triphosphate (ATP)

114
Q

Phosphate present in Promotes hemoglobin affinity to oxygen

A

2,3-Biphosphoglyceric acid

115
Q

Phosphates present in Coenzyme

A

phosphoric/pyrophosphoric acid

116
Q

Total phosphate in blood:

117
Q

Phosphates may exist as

A

Organic Phosphate
Inorganic Phosphate

118
Q

Organic phosphate how much

119
Q

Inorganic phosphate how much

120
Q

principal intracellular anion

A

Organic Phosphate

121
Q

part of blood buffer

A

Inorganic phosphate

122
Q

can maintain blood pH

A

Inorganic phosphate

123
Q

the ONLY type measured in the
laboratory

A

Inorganic phosphate

124
Q

Forms of Phosphorus

A

→ Free/Unbound
→ Complexed with ions
→ Protein-bound

125
Q

Percent of free/unbound phosphorus

126
Q

Percent of phosphorus complexed with ions

127
Q

Percent of protein-bound phosphorus

128
Q

Regulation of phosphate:

A

A. Parathyroid hormone
B. Vitamin D
C. Growth hormone

129
Q

(↓PO4-)

A

Parathyroid hormone

130
Q

(↑PO4-)

A

Vitamin D
Growth hormone

131
Q

Decreases phosphate by renal excretion

A

Parathyroid hormone

132
Q

Increases _______________ and ______________ absorption of phosphate

A

Vitamin D
Intestinal and Renal

133
Q

Increased phosphate renal reabsorption

A

Growth hormone

134
Q

Decreased plasma phosphate concentration

A

HYPOPHOSPHATEMIA

135
Q

Very critical for a patient

A

HYPOPHOSPHATEMIA

136
Q

why is HYPOPHOSPHATEMIA very critical for a patient?

A

ATP relies on phosphate

137
Q

(low/high) PO4- may lead to ATP depletion

138
Q

Severe hypophosphatemia

A

<1.0 mg/dL

139
Q

Causes of Hyphophosphatemia

A
  1. Alcoholism
  2. Vitamin D Deficiency
  3. Renal Tubular Acidosis
  4. Hyperparathyroidism
  5. Rickets
  6. Fanconi Syndrome
  7. Transcellular shift
140
Q

most common of hypophosphatemia

A

Alcoholism

141
Q

Alcoholism
→ most common of hypophosphatemia bec. it
impairs absorption of phosphate in the
_________

142
Q

CAUSES

↑PO4-

A

Vitamin D Deficiency

143
Q

CAUSES

PTH (inc/dec)PO4- (by inc. renal excretion)

144
Q

major cause of hypophosphatemia

A

Transcellular shift

145
Q

PO4- in the blood that enters the cell = (inc/dec) PO4- in plasma

A

Transcellular shift
dec

146
Q

at risk are patients with Acute/Chronic Renal
Failure

A

HYPERPHOSPHATEMIA

147
Q

Causes of HYPERPHOSPHATEMIA

A
  1. Renal Disease
  2. Hypoparathyroidism
  3. Excess Vitamin D
  4. Acromegaly
  5. Lymphoblastic Leukemia
148
Q

Leading cause of Hyperphosphatemia

A

Renal Disease

149
Q

increased GH that (inc/dec) PO4-

A

Acromegaly
inc

150
Q

_____________ (immature lymphocytes) have
_____ more phosphate compared to
lymphocytes

A

Lymphoblastic Leukemia
lymphoblasts
4x

151
Q

Specimen used in the laboratory analysis of Phosphate

A

Serum
Heparinized plasma
24hr urine

152
Q

Variables in the laboratory analysis of phosphates

A

Hemolysis
Circadian Rhythm
Other anticoagulants

153
Q

Hemolysis in laboratory analysis of phosphates causes false (inc/dec)

154
Q

Hemolysis is false increase due to higher phosphate in ____ compared to _______

155
Q

natural changes that occurs in the body within 24 hrs

A

Circadian Rhythm

156
Q

_______ - highest phosphate

A

Late morning

157
Q

__________ - lowest phosphate

158
Q

Other anticoagulants that is a variable in the laboratory analysis of Phosphates that may interfere with the methods

A

EDTA
Citrate,
Oxalate

159
Q

Laboratory method for phosphates

A
  1. Fiske Subbarow Method (aka Ammonium
    Molybdate Method)
160
Q

Most commonly used method for measuring
inorganic phosphate

A

Fiske Subbarow Method (aka Ammonium
Molybdate Method)

161
Q

Principle:

Phosphorus + ammonium molybdate –> __________________________________ (340 nm)

A

ammonium phosphomolybdate

162
Q

Principle

ammonium phosphomolybdate + pictol –»» _____________________ (600 nm)

A

molybdenum blue

163
Q

colorless end product ; measured at
340 nm

A

Ammonium phosphomolybdate:

164
Q

what region is Ammonium phosphomolybdate:

165
Q

most accurate method

A

Ammonium phosphomolybdate

166
Q

Alternative method: If UV spectro is not
available, ______ can be added

A

reducing agent

167
Q

The addition of RA, will facilitate the
formation of __________________
measured at 600 nm (_______ region)

A

molybdenum blue
visible

168
Q

Disadvantage:

___________ pH = reduction of molybdenum blue (false (inc/dec)))

A

Alkaline
decrease

[Lecture] CC II (3 decks)

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