Exam 3: Calcium/phosphate Flashcards
Total Ca2+ concentration in blood
10 mg/dl
40% of total blood calcium is bound to ____ and 60% is ____
Plasma proteins; unbound
Of the unbound calcium 10% is complexed to which anions
Phosphate
Sulfate
Citrate
Of the unbound calcium 50% is
Ionized Ca2+
What is the only form of calcium that is biologically active
Ionized Ca2+
Hypocalcemia has what effects on body
Hyper-reflexia Spont. Twitching Muscle cramps Tingling Numbness
Hypocalcemia lowers the threshold potential of
Muscle and nerves
Easier to excite
Chvostek sign = twitching of facial muscles elicited by
Tapping on CN7
Trousseau sign is a carpopedal spasm after
Inflation of sphygmomanometer (BP cuff)
Hypercalcemia neurologic signs
Hyporeflexia
Lethargy
Coma — death
Hypercalcemia can also lead to
Constipation
Polyurea
Polydipsia
Increase in concentration is associated with
Inc in total Ca2+
Changes in anion concentration is ____ proportional to changes in ionized Ca2+
Indirectly
Acidemia ultimately causes _____ in ionized Ca2+
Inc
Bc more H+ binds to albumin, displaces Ca2+
Alkalemia ultimately causes ____ in ionized Ca2+
Dec
Bc less H+ binds to albumin
Calcium homeostasis involves 3 organ systems
Bone
Kidney
Intestine
Overall calcium homeostasis involves 3 hormones
PTH
Calcitonin
Vitamin D
Role of PTH
Regulate Ca2+ ECF concentration
Dec plasma Ca2+ causes ____ PTH from parathyroid glands
Inc secretion
____ cells synthesize and secrete PTH
Chief
Secretion of PTH is regulated by
Plasma Ca2+ concentration
PTH is secreted when plasma Ca2+ concentration goes below _____
10 mg/dl
Maximal secretion of PTH occurs at
7.5 mg/dl
Chronic hypocalcemia leads to
Secondary hyperparathyroidism
Chronis hypercalcemia leads to
Dec synthesis/storage of PTH
Inc breakdown of stored PTH
Magnesium effect on PTH
Similar to Ca2+
Hypomagnesia
Stims PTH secretion
Severe hypomagnesia is associated w/
Alcoholism
Inhibits PTH synthesis, storage and secretion
Hypermagnesia
Inhibits PTH secretion
At the renal proximal tubule PTH inhibits _____ and results in
Renal phosphate reabsorption; phosphaturia
At the distal convoluted tubule PTH stimulates
Ca2+ reabsorption
PTH has ____ effect on kidney mediated by cAMP
Direct
PTH has ____ effect on intestine via activation of Vit D
Indirect
Inc calcium absorption via Vit D
PTH in bone: receptors located only on
Osteoblasts
PTH initially and briefly ____ bone formation
Inc
PTH causes an ___ in bone resorption
Inc
Net effect of PTH over long haul in bone is
Bone resorption
Causes inc in Ca2+ and phosphate to ECF
PTH stimulates renal 1a-hydroxylase which converts
25-hydroxycholecalciferol — 1,25 dihydroxycholecalciferol
1,25 dihydroxycholecalciferol AKA
Active form of vitamin D
Active vitamin D stimulates
Intestinal Ca2+ absorption
Primary hyperparathyroidism MC caused by
Parathyroid adenoma
Primary hyperparathyroidism causes glands to secrete lots of PTH which causes
Hypercalcemia
Hypophosphatemia
Primary hyperparathyroidism causes excretion of excessive amounts of
Ca2+
CAMP
Phosphate
All can form kidney stones
Kidney stones are formed as a result of Ca2+ precipitating as
Ca2+ phosphate
Ca2+ oxalate
Primary hyperparathyroidism
Secondary hyperparathyroidism
Parathyroid normal
Stim to secrete PTH secondary to hypocalcemia
Hypocalcemia in secondary hyperpara due to
Vit D deficiency
Chronic renal failure
Other aspects of secondary hyperparathyroidism
High PTH
Low/normal plasma Ca2+
How to differentiate primary and secondary hyperparathyroidism
Plasma Ca2+ low/normal (secondary)
Plasma Ca2+ high (primary)
Hypoparathyroidism is a common consequence of
Thyroid surgery
Hypoparathyroidism causes
Low PTH
Hypocalcemia
Hyperphosphatemia
Pseudohypoparathyroidism
Gs receptor protein for PTH in kidney/bone is defective
Doesn’t activate adenylyl cyclase
Pseudohypoparathyroidism AKA
Albright’s hereditary osteodystrophy
Pseudohypoparathyroidism causes
Hypocalcemia
Hyperphosphatemia
Pseudohypoparathyroidism physical characteristics
Short stature/neck
Obesity
Subcutaneous calcification
Shortened 4th metacarpals/tarsals
Humoral hypercalcemia of malignancy
Malignant tumors secrete peptide that is similar to PTH
Humoral hypercalcemia of malignancy causes
Hypercalcemia
Hypophosphatemia
Humoral hypercalcemia of malignancy has similar findings to primary hyperpara except
Low PTH
Suppressed by hypercalcemia
Humoral hypercalcemia of malignancy is treated w/
Furosemide — inhibits renal Ca2+ reabsorption
Etidronate — inhibits bone resorption
Familial hypocalciuric hypercalcemia characterized by
Dec urinary Ca2+ excretion
Inc plasma Ca2+
FHH caused by mutation of Ca2+ receptors in
Parathyroid glands
Kidney
FHH has ___ PTH levels
high (not inhibited as it should be)
Calcitonin is synthesized by
Parafollicular cell of thyroid
Calcitonin is stored in
Secretory granules
What stimulates calcitonin secretion
Inc plasma Ca2+
Calcitonin inhibits ____ which leads to ___ plasma Ca2+
Osteoclast bone resorption; Dec
Vitamin D promotes
Mineralization of new bone
Vitamin D increases plasma levels of
Ca2+ and phosphate
Vitamin D is a ___ hormone
Steroid
Major site of action of vitamin D
Intestine
In intestine vitamin D inc _____ absorption
Ca2+ and phosphate
Vitamin D induces synthesis of
Calbindin D-28 K
Calbindin D-28 K
Protein that binds 4 Ca2+
May act as shuttle or help to maintain gradient
Vitamin D actions in kidney
Inc Ca2+ and phosphate
Vitamin D in bone, acts synergistically w/ ___ to stimulate ____
PTH; osteoclast activity and bone resorption
Vitamin D deficiency in children
Rickets
Rickets: insufficient amounts of ____ which causes ____
Ca2+ and phosphate
Growth failure/skeletal deformities
Vitamin D deficiency in adults
Osteomalacia
Osteomalacia characterized by
New bones failing to mineralize — softening of bones
Deficiency of vitamin D effect on other organs
CV disease Cancer Infection MS Childhood asthma
Other functions of vitamin D
Controls genes Dec cell proliferation Immunomodulator Controls inflamm Muscle strength BP
Vitamin D deficiency effect on muscles
Muscle weakness
Vitamin D effect on BP
Inhibits renin secretion
Vitamin D effect on inflamm
Lack of Vit D = inc CRP and IL-10
In response to TB/LPS Vitamin D genes are upregulated which causes inc production of
Cathelicidin — powerful antimicrobial
Chronic renal failure characterized by dec production of
Active Vit D
Chronic renal failure has ___ PTH levels and ___ bone resorption of Ca2+
High; inc
Chronic renal failure causes
Osteomalacia
Chronic renal failure exhibits ___ urine phosphate which ___ plasma phosphate
Dec; inc
Chronic renal failure ___ plasma Ca2+
Dec