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GI Exam 1 > Fluid and Electrolytes Ca and PO4^-3 > Flashcards

Fluid and Electrolytes Ca and PO4^-3 Flashcards

1
Q

Normal Calcium

A

8.5-10.5 mg/dL

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2
Q

Where is the calcium in the body

A

> 99% in skeleton

ECF has 0.5%

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3
Q

ECF Calcium

A

about 46% is bound to albumin

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4
Q

What is the active form of Calcium

A

Ionized or free Calcium

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5
Q

Most common cause of hypocalcemia

A

Hypoalbuminemia

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6
Q

Reduced serum calcium + PO4^3-

A

Elevated phosphorous can cause reduced Ca

Reduced Ca can lead to increase PTH

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7
Q

Increased parathyroid hormone secretion leads to

A

Increased clast and blast in bone to increase Ca mobilzation
Increased renal Ca reabsorption and decrease PO4 reabsorption
Increased renal activation 1,25 dihydroxy vit D3

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8
Q

Increased clast and blast in bone to increase Ca mobilzation & increased renal Ca reabsorption and decrease PO4 reabsorption leads to

A

Increased serum Ca which leads to increased calcitonin

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9
Q

Increased renal activation 1,25 dihydroxy vit D3 leads to

A

Increased intestinal Ca and PO4 absorption which leads to increased serum Ca which leads to increased calcitonin

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10
Q

Hypocalcemia can be seen in

A

Elderly
Malnourished pts
Pts receiving NaPO4

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11
Q

Causes of hypoCa

A 
Vit D deficiency (renal failure)
HypoMg
Tissue consumption of Ca
Hungry bone syndrome (renal failure)
Drug Induced
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12
Q

Vitamin D + Ca

A

Activation of Vit D leads to increased Ca/P absorption so if there is not enough Vit D there is not enough Ca/P absorption

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13
Q

HypoMg + Ca

A

Unresponsive to replacement and unresponsive to PTH

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14
Q

TIssue consumption of Ca

A

Sever pancreatitis secondary to Ca turning into SOAP
Sepsis
Rhabdo

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15
Q

Hungry Bone Syndrome + Ca

A

Recent thyroidectomy

Bone is avidly incorporating Ca/P into bone

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16
Q

Drug induced hypoCa

A

Furosemide, calcitonin, bisphosphonates
Chelating agents (citrate and EDTA)
Ethylene glycol

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17
Q

Symptoms of hypoCa

A

Increased pH (more Ca bind to albumin)
Muscle cramps, tetany
Depression, anxiety, confusion
Prolong QT interval

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18
Q

Chvostek’s sign + HypoCa

A

Tap on their cheek and their mouth comes up

19
Q

Trousseau’s Sign + HypoCa

A

Put a blood pressure cuff on pt and their hand will retract towards arm

20
Q

HyperCa + EKG

A

Shortened ST interval

Arrhythmias

21
Q

HypoCa + EKG =

A

Prolong ST interval

22
Q

Acute Symptomatic Hypocalcemia Treatment

A

100-300 mg of Ca IV over 5-10 minutes (gluconate)

- Last for 1-2 hours so continuous infusion of 0.5-2 mg/kg/hr

23
Q

Rate of Ca infusion

A

No more than 60 mg per minute bc of cardiac dysfunction

24
Q

Ca + Precipitation

A

Don’t add bicarbonate or phosphate

25
Q

Chronic Asymptomatic HypoCa Treatment

A 
If hypoMg, give Mg
No bisphosphonates bc of hungry bone
Oral Ca and Vit D
- Ca: 1 to 3 g/day up to 2 to 8 g/day
- D: 50,000 u/d but if renal use 1,25 OH D3 0.5-3 mcg/d
26
Q

Calcium chloride =

A

27% elemental Ca

- Often leads to hyper symptoms due to high potentcy

27
Q

Calcium gluconate =

A

9% elemental Ca

28
Q

Normal Phosphate

A

2.5-4.5 mg/dL

29
Q

Phosphorus is needed for

A 
Cell membranes, nucleic acids, mitochondrial function
Enzymatic reaction regulation
Oxygen and hemoglobin dissociation
High energy bonds of ATP
Bone formation
30
Q

***Phosphorus is mainly

A

intracellular

SERUM LEVELS DO NO ACCURATELY REFLECT TOTAL BODY STORES

31
Q

Normal Levels for Children less than 12

A

4-5.6 mg/dL

32
Q

Phosphorous homeostasis

A

Western Diet provides 800-1600 mg and 60-80% is absorbed

  • Low Vit D and low P increase absorption
  • Reabsorption is inhibited by PTH and increased Vit D3
33
Q

Mild to moderate hypoP

A

1-2 mg/dL

34
Q

Sever hypoP

A

less than 1 (symptoms)

35
Q

Causes

A

Decreased GI absorption
Reduced tubular reabsorption
Internal redistribution

36
Q

Decreased GI absorption causing hypoP

A 
P binding drugs: aluminum agents, sevelamer
Decreaseintake
Glucocorticoids
Vit D def
Hypoparathyroidism
Diarrhea
Steatorrhea (fat in the poop)
37
Q

Reduced tubular reabsorption causing hypoP

A

Hyperparathyroidism
Burn recovery
Faconi syndrome

38
Q

Internal redistribution causing hypoP

A 
Refeeding syndrome
IV nutrition
Parathyroidectomy (hungry bone)
Insulin
Glucagon
Calcitonin
39
Q

Define refeeding syndrome

A

Mitochondria are so starved for energy bc no enough P that when it enters it goes ECF to ICF and paralyzes the body

40
Q

Major conditions associated with severe hypoP

A

Alcoholism, IV TPN
Antacids
Treatment of severe DKA

41
Q

Symptoms of hypoP

A 
Encephalopathy
Impaired myocardial contracility (CHF)
Myopathy, dysphagia
Hemolysis, defective clotting
Prolonged rickets and osteomalacia
42
Q

Treatment of HypoP

A

12-14 mmol/L to TPN
Infusion fof 15 mmol/250 mL of D5W or NS over 3 hours
Doses of 15-30 mmol can be given over 1-3 hrs if pts has normal Ca

43
Q

Monitoring with treatment of HypoP

A

Q6H

44
Q

Mild-moderate or asymptomatic hypoP Treatment

A

Oral P salts 1.5-2 g daily in divided doses and should correct in 7-10 days
- Renal insufficiency reduced to 1 g

GI Exam 1 (8 decks)

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