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STEP 2 Cardio + Renal > fluid/acid-base HYPER Ca > Flashcards

fluid/acid-base HYPER Ca Flashcards

1
Q

Hyper Ca FA. Causes.
3 groups?

ALBUMIN!!!!!!

A

Hyperparathyroidism
Malignancy (breast, squamous cell, multiple myeloma)

menumonic: CHIMPANZEES

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2
Q

Hyper Ca Causes. CHIMPANZEES?

A

Ca supplementation
Hyperparathyroidism
Iatrogenic (thiazides, parenteral nutrition, immobility)
Milk-alkali syndrome (excessive intake of calcium and absorbable alkali)
Paget disease
Adrenal insuf/Acromegaly
Neoplasm
Zollinger-elison (eg. MEN 1)
Excess vitA
Excess vit D
Sarcoidosis or other granulomatous disease

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3
Q

Hyper Ca FA. Symptoms?

A

Asymtomatics
Symptoms - bones, stones, abdominl groans, pshichiatric overstones

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4
Q

Hyper Ca FA. Bones symptoms?

A

Osteopenia, fractures

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5
Q

Hyper Ca FA. Stones symptoms?

A

kidney stones

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6
Q

Hyper Ca FA. abdominal groans symptoms?

A

anorexia, constipation

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7
Q

Hyper Ca FA. prichiatric overtones symptoms?

A

weakness, fatige, irritability, altered mental state

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8
Q

Hyper Ca FA. Best initial test?

A

Check total/ionized calcium and albumin

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9
Q

Hyper Ca FA. reasoning of checkin Ca and albumin?

A

Ca bounded to albumin.
Changes in albumin conc. can lead to Ca conc. alterations, that do not necessarily affect ionized calcium (physiologic active form).

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10
Q

Hyper Ca Uptd.

Bound to plasma proteins (approximately 40 to 45 percent), notably albumin;

partly bound to small anions such as phosphate and citrate (approximately 15 percent);

and partly in the free or ionized state (approximately 40 to 45 percent).

A

.

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11
Q

Hyper Ca what ratio decr. albumin and Ca?

A

0,8 mg/dl fall for every 1g/dl

0,25 mmol/l for 10 g/l

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12
Q

Hyper Ca Corrected: For every gram of albumin above or below 4, the serum calcium is corrected, down or up, respectively, by 0.8 mg/dL.

A

.

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13
Q

Hyper Ca

corrected Ca formula (Payne’s formula)?

A

Corrected Ca (mmol/l) = measured Ca mmol/l + 0,02 x (40 - albumin g/L)

SITOS REIKS pagal vienetus: Corrected Ca (mg/dl) = measured Ca + 0,8 x (4- albumin g/dL)

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14
Q

Hyper Ca
FA. After checking Ca/albumin. what need to consider?

A

Phosphate, Mg, PTH, creatinine, alkaline phosphatase levels.

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15
Q

Hyper Ca
FA.
What tests for further evaluation? malignancy

A

PTHrP (PTH related peptide)

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16
Q

Hyper Ca
FA.
What tests for further evaluation? multiple myeloma

A

serum electrophoresis

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17
Q

Hyper Ca
FA.
What tests for further evaluation? granulomatous disease, iatrogenic vit … intake, TB suspected

A

vit D levels

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18
Q

Hyper Ca.
Other workups?

A

ECG may show shortened QT interval

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19
Q

Moderate hyper Ca total range?

A

3-3,5

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20
Q

Mild hyper Ca total range?

A

above 3 mmol/.

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21
Q

severe hyper Ca total range?

A

> 3,5

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22
Q

normal ionized?

A

1.2 to 1.4 mmol/L

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23
Q

Mild hyper Ca ionized range?

A

1.4 to 2 mmol/L

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24
Q

moderate hyper Ca ionized range?

A

2 to 2.5 mmol/L

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25
Q

severe hyper Ca ionized range?

A

2.5 to 3 mmol/L

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26
Q

Hyper Ca pagal etiologijos nustatyma, koks pirmas istyrimas?

A

PTH.

Tada nustatom ar cia su relatad or non related to parathyroid

If elevated - cause parathyroid

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27
Q

Hyper Ca uptd. parathyroid mediated? causes

A

Primary hyperparathyroidism (sporadic)

Inherited variants: MEN, Familial isolated hyperparathyroidism, Hyperparathyroidism-jaw tumor syndrome

Familial hypocalciuric hypercalcemia

Tertiary hyperparathyroidism (kidney failure)

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28
Q

Hyper Ca uptd. non - parathyroid mediated? causes

A

Hypercalcemia of malignancy
Vit D intox
Granulomatous diseases

Drugs: Thiazide diuretics, Lithium, vit A excess

other: Hyperthyroidism, Acromegaly, Pheochromocytoma, Adrenal insufficiency, Immobilization, Parenteral nutrition, Milk-alkali syndrome

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29
Q

Hyper Ca FA diagnostic algo.
1st 2 steps?

A

Hypercalcemia (corrected Ca)
then
PTH concentration

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30
Q

Hyper Ca FA diagnostic algo.
If PTH high-normal?

A

its PTH dependent hypercalcemia

31
Q

Hyper Ca FA diagnostic algo.
If PTH dependent hypercalcemia?

A

Check urine Ca

32
Q

Hyper Ca FA diagnostic algo.
PTH dependent hypercalcemia. What if urine Ca low or high?

A

Low - familial hypercalcemic hypocalciuria

High - 1 and 3 hyperparathyroidism

33
Q

Hyper Ca FA diagnostic algo.
If PTH low?

A

Its PTH independent hypercalcemia

34
Q

Hyper Ca FA diagnostic algo.
PTH independent hypercalcemia. What to check then?

A

Vit D (25 OH and 1,25)
PTH related protein

35
Q

Hyper Ca FA diagnostic algo.
PTH independent hypercalcemia. High 25OH?

A

Vit D intox

36
Q

Hyper Ca FA diagnostic algo.
PTH independent hypercalcemia. High 1, 25 OH?

A

sarcoidosis, lymphoma

37
Q

Hyper Ca FA diagnostic algo.
PTH independent hypercalcemia. Inc. PTHrP?

A

Breast cancer, squamous cell, ovarian, renal cancers

38
Q

Hyper Ca FA diagnostic algo.
PTH independent hypercalcemia. normal vit D and PTHrP?

A

Multiple myeloma, immobilization, hyperthyroidism, vit A tox, acromegaly, milk-alkali syndrome

39
Q

Fa Hyper Ca treatment. 1 st thing?

A

treat underlying cause

40
Q

Fa Hyper Ca treatment.
If mild hyperCa (corected calcium < 12 mg/dL)?

A

does not require urgent treatment.

Maintain hydration (to prevent stones) + avoid factors that can worsen hyper Ca (thiazides, high Ca intake, inactivity)

41
Q

Fa Hyper Ca treatment.
If severe hyper Ca > 14 mg/dL?

A

Need urgent treatment.

Isotonic fluids (+/- furosemide) and calcitonin

Consider bisphosphonates (zoledronic acid, pamidronate)

42
Q

Fa Hyper Ca treatment.
If severe hyper Ca > 14 mg/dL. Intake of sodium what effect?

A

High intake of Na (in isotonic) facilitates renal calcium excretion and prevents renal complications (stones)

43
Q

Fa Hyper Ca treatment.

If 12-14 mg/dl, but asymptomatic?

A

not needed emeregency treatment.

They may follow same precautions as for mild + therapies eg isotonic fluids ——> to facilitate Ca excertion

44
Q

Fa. HYPO Ca.

range

A

< 8,5 mg/dl

45
Q

Fa. HYPO Ca.
etiologies? 3 groups

A

Parathyroid related
Malnutrition/vit D deficiecy
Other: hypoMg, pancreatitis, chelation from blood products

46
Q

Fa. HYPO Ca.

Parathyroid related causes?

A

Hypoparathyroidism (idiopathic, postsurgical), CKD (causing secondary hyperparathyroidism,
pseudohypoparathyroidisim (PTH resistance)

47
Q

Fa. HYPO Ca.

Parathyroid related cause in infants?

A

Di George syndrome

48
Q

Fa. HYPO Ca.
Symptoms?

A

Abdominal and muscle cramps, dyspnea, tetany, perioral and acral paresthesias, convulsions

49
Q

mneumonic:
Loop diuretics = Loose Calcium

Thiazide - inc. Tubular reabs. of Ca

50
Q

clasical patient of hypoCa?

A

hypoCa in patient with tetany and cramps following thyroidectomy - because of parathyroidectomy as a complication

51
Q

classical presentation on Hypo Mg in what patients?

A

alcoholics

52
Q

Fa. HYPO Ca.
Typical facial symptom?

A

Facial spasms elicited from tappin on facial nerve (Chvistek sign)

53
Q

Fa. HYPO Ca.
Typical hand symptom?

A

carpal spasm after arterial occlusion by BP cuff (Trousseau sign)

54
Q

Fa. HYPO Ca. most accurate tests?

A

Ionized Ca and PTH.

55
Q

Fa. HYPO Ca.
after ionized Ca and PTH. What other tests?

A

Mg (low level can induce PTH resistance)
Albumin
25OH and 1,25 OH vit D
electrolyte

BUN, creatinine, alkaline phosphatase may also be useful depending on clinical situation

56
Q

Fa. HYPO Ca. other than lab workup?

A

ECG - prolonged QT interval

57
Q

Fa. HYPO Ca. treatment. first?

A

underlying cause

58
Q

Fa. HYPO Ca. treatment.
route?

A

p/os - in most cases
I/v in more severe

59
Q

Fa. HYPO Ca. treatment. what apart Ca?

A

ensure Mg repletion

60
Q

uptd. what is severe/acute hypo Ca?

A

● Symptoms (eg, carpopedal spasm, laryngospasm, bronchospasm, seizures, decreased cardiac function)
● A prolonged QT interval

OR

●In asymptomatic patients with an acute decrease in serum corrected calcium to ≤7.5 mg/dL (≤1.9 mmol/L), who may develop serious complications if untreated

61
Q

uptd. hypo Ca. in CDK but asymtomatic/mild symptoms, what treat?

A

correction of hyperphosphatemia and of low circulating 1,25-dihydroxyvitamin D are usually the primary goals. intial therapy with Ca is not waranted

62
Q

uptd. initial treatment for severe hypoCa?

A

Initially, IV calcium (1 or 2 g of calcium gluconate, equivalent to 90 or 180 mg elemental calcium, in 50 mL of D5W or NS) can be infused over 10 to 20 minutes.

may repeat after 10-60 min is symptoms persist.

then infusion: Patients typically require 0.5 to 1.5 mg/kg of elemental calcium per hour.

durnas skiedimas nurodytas, tipo 1litra saline arba D5W ideti 11g Cagluc ir uzstatyti and 50 ml/h

63
Q

10 proc 10 ml = 1000mg (100 mg /ml)
Elemental calcium 9,3 mg/ml

64
Q

uptd. HypoCa. Concurent hypoMg. what treatment?

A

2 g (16 mEq) of magnesium sulfate should be infused as a 10% solution over 10 to 20 minutes, followed by 1 gram (8 mEq) in 100 mL of fluid per hour

65
Q

Fa. hypoMg. range?

A

< 1,5 mEq/l

66
Q

Fa. hypoMg. etiologies? 3

A

decr. intake
incr. loss
miscelaneous

67
Q

Fa. hypoMg. decr. intake causes?

A

malnutrition, malabsorbtion, short bowel syndrome, total parenteral nutrition, PPI drugs

68
Q

Fa. hypoMg. inc. loss causes?

A

diuretics, diarrhea, vomiting, hyperCa, excessive alcohol use

69
Q

Fa. hypoMg. miscelaneous causes?

A

DKA, pancreatitis, ECF expansion

70
Q

Fa. hypoMg. Symptoms?

A

hyperactive reflexes, tetany, paresthesias, irritability, confusion, lethargy, seizures, arrhythmias.

71
Q

Fa. hypoMg. diagnosis? 2 steps

A

labs: shows concurent hypoCa and hypoK

ECG - prolonged PR and QT

72
Q

Fa. hypoMg. treatment?

A

i/v or oral supplementation=

73
Q

Fa. what is must to correct hypo Ca and Hypo K.

A

Magnesium.

HypoK and hypoCa will not correct without magnesium correction

STEP 2 Cardio + Renal (55 decks)

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