Hypercalcemia Flashcards
When you see hypercalcemia what other value should you look at on the chemistry?
Phosphorus
What are the different forms of calcium?
50% Ionized
40% Protein Bound
10% Complexed
Total measured in clinic
Where is most calcium loacted?
In the bone
How do you measure total calcium?
Measure the Serum
What is the active form of calcium that causes effects?
Ionized
Describe parathyroid hormone regulation and function:
Parathyroid makes PTH that goes to bone, kidney and intestine to increase ca in blood/extracellular when it senses a decrease
Measure PTH
What are some causes of hypercalcemia?
Excessive absorption
Vitamin D toxicosis - more from GIT
More tubular resorption/decreased GFR
Hyperparathyroidism (from bone) - adenoma of parathyroid gland
Hypoadrenocorticism - steroid ca from kidney
Cancer- malignancy - Lymphosarcoma, Anal Sac Adenocarcinoma
Idiopathic
Granulomatous disease
Bone lysis
Renal Failure
Lab Error
What are the changes in hormones for Hyperparathyroidism?
tca, ica phos and PTH and PTHrP
Tca: Increase
Ica: Increase
Phos: Decrease or normal
PTH: Normal or increase
PTHrP: Normal
What are the changes in hormones for Acute Kidney Injury?
tca, ica phos and PTH and PTHrP
Tca: Increase
Ica: Increase or Decrease
Phos: Normal - Increase
PTH: Increase
PTHrP: Normal
What are the changes in hormones for Vitamin D toxicosis ?
tca, ica phos and PTH and PTHrP
Tca: Increase
Ica: Increase
Phos: normal to increae
PTH: Decrease
PTHrP: Normal
What are the changes in hormones for malignancy?
tca, ica phos and PTH and PTHrP
Tca: Increased
Ica: Increase
Phos: Normal to increase
PTH: Decrease
PTHrP: Increase
What are the 3 types of renal disease category?
Prerenal: USG concentrated
Renal: USG poorly concentrated or isosthenuria
Post Renal: USG vary
Can calcium injure the kidney? Can damage kidneys increase ca?
Yes both
What effects does calcium have on the kidney?
Nephrogenic diabetes insipidus
-impair collecting tubule to ADH
-Decreased aquaproin
-hyposthenua
Renal arteriolar vasconstriction
Renal Mineralization
What are signs of hypercalcemia?
ca>15
PU/PD
Anorexia/hyprexia
Lethargy
Weakness
Cardiac arrythmias
Seizure/muscle twitch
Why do PU and PD occur with hypercalcemia?
Increased water consumperion
Reduced tubular function, excess solute
Deficency or impaired response to ADH
What are causes of PTH independent hypercalcemia?
Lymphosarcoma
Anal sac adenocarcinoma
Neoplasia
Renal Failure
Hypoadrenocortism
Vitamin D toxicosis
Granulomatous disease
Bone lysis
How should you work up hypercalcemia?
Double check TCA
Check PTH and Ca
Thoracic rad, abdominal ultrasound, rectal, cortisol, bone marrow aspirate, fungal test
What are some aggressive treatments for hypercalcemia?
IV NaCl
Furosamide
Thiazides Bisphosphate
What are some maintenance therapies for hypercalcemia?
Oral corticosteroids
Oral alendronate
