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Hypercalcemia and Hypophosphatemia Flashcards

1
Q

What is normal serum calcium

A

8.5-10.5 mg/dl

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2
Q

What is normal ionized serum calcium

A

4.4-5.4 mg/dl

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3
Q

What protein has to be accounted for when referring to to total Calcium, does this protein cause any change in ionized Calcium

A

Albumin,no

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4
Q

What is the equation for corrected Calcium

A

(total measured serum calcium) + 0.8(4- measured serum albumin)

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5
Q

What is the normal serum albumin level

A

4 mg/dl

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6
Q

How does PTH affect bones,kidneys, and the gut

A

stimulates osteoclasts and cause bone breakdwon, increases reaborption of calcium in distal renal tubules, indirectly increases intestinal calcium absoption

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7
Q

What causes calcitonin to be increased

A

When ionzied calcium concentrations are high

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8
Q

What are ways hypercalcemia can occur

A

accelerated bone resporption, Excessive GI absorption, decreaed renal excretion of calcium

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9
Q

What are the ranges for hypercalcemia with respect to total serum calcium, ionized calcium

A

greater than 10.5, greater than 5.4

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10
Q

What is the disease that accounts for 90% of cases of hypercalcemia

A

primary and secondary hyperparathyroidism, malignancy

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11
Q

What is the cause of primary hyperparthyroidsim, secondary, tertiary

A

parathyroid adenoma, hyperplasia of the glands (adaptive disease in the setting of CKD), advanced renal failure

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12
Q

How high can calcium get due to malignancy

A

over 13 mg/dl

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13
Q

What are drugs that cause hypercalcemia

A

ergocalciferol, calcitrol, cholecalciferol, litihium, vitamin A, thiazide diuretics

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14
Q

How do thiazide diuretics cause hypercalcemia

A

increase renal tubular reabsorption of calcium in distal tubule, block Na reabsorption and increase calcium reabsorption, lowers urinary calcium excretion

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15
Q

What are moderate hypercalcemia total serum calcium levels, severe

A

12-14 mg/dl, greater than 14 mg/dl

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16
Q

What are symptoms of severe hypercalcemia

A

profound dehydration, renal failure, cardiovascular/neuromuscluar dysfunction, coma

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17
Q

What is the fluid that is used to treat severe hypercalcemia, why

A

09.% normal saline with loop diuretics to help increase calcium excretion, corrects volume depletion/increases renal excretion of calcium

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18
Q

Which treatment will cause rapid decrease in serum calcium

A

calcitonin

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19
Q

What treatment provides sustained effect in lowering calcium

A

Bisphosphonates

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20
Q

What is the last restort for hypercalcemia

A

Dialysis

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21
Q

What is the dose of normal saline in hypercalcemia

A

200-300 ml/hr, could be lower with older patients

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22
Q

What is the mechanism for calcitonin

A

Functionally antagonizes the PTH

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23
Q

What is the does for calcitonin, how can it be administered

A

4 IU/kg, IM/SC

24
Q

T/F: The efficacy of calcitonin is limited to the first 72 hours and if responsive can repeat every 4-6 hours

A

False: The efficacy is limited to the 1st 48 hours and if responsive can be repeated every 6-12 hours from dose

25
T/F: The nasal formulation of Calcitonin does not work
True
26
What is the duration of bisphosphonates, when does the max effect take place
2-4 weeks, 2-4 days
27
What type of bisphosphonate is most commonly used in hypercalcemia, what is the dose
Zolendronic Acid, 4 mg IV over 15 minutes
28
When should bisphosphonates be avoided in a patient
if CrCl is less than 30ml/min
29
How often will bisphosphonates be administered in malignancy, what drug is administered as well and why
every 3 to 4 weeks, denosumab for refactory hypercalcemia
30
What is the role of glucocorticoids, what is one way they work
hypercalcemic presentation due to drugs or disease, decrease intestinal calcium
31
What drug can be used for chronic hypercalmia in hyperparathyroidism
sensipar (cinacalcet) and Parsabiv (etelcalcetide)
32
What is the starting dose for sensipar
30 mg daily with food
33
What is the dosing for parsabiv
5 mg IV bolus 3 times per week at the end of hemodialysis
34
T/F: When calcium is greater than or equal to 15 parental therapy is required
True
35
What creatine clearence is bad for bisphosphanates
30
36
What is a normal phosphorous range
2.5-4.5 mg/dl
37
What is the organ that affects phosphours levels the most
kidney
38
What inhibits phosphorous reabsorbtion
PTH and calcitrol
39
What are moderate and severe ranges of hypophosphatemia
1.5 mg/dl, less than or equal to 1 mg/dl
40
What the four key ways hypophosphatemia can occur
Redistribution of phosphate from extracellular fluid into cells, decreased intestinal absoprtion of phosphate, removal by renal replacement therapies
41
Where is phosphorous absorbed
From the intestines
42
What are the symptoms due to consequences of intracellular phosphorous depletion
Reduce oxygen tissue release, ATP levels fall and cell functions begin to fail
43
How low does phosphate usually get to cause symptoms
less than 1.0
44
Which oral phosphorous has the least amount of potassium
K phos neutral
45
T/F: A patient will receive IV phos therapy whether they are symptamatic or not
True
46
When should IV phos be switched to PO therapy
Once over 1.5
47
What is the IV dose for symptomatic patients with phosphorous greater than 1.5, less than 1.5
Max 30 mmol over 6 hours, max 80 mmol over 8-12 hours
48
When should phosphorous doses be lower, held off
Ca is around 10.5 to 12 cut the dose in half, renal dysfunction, if the Ca is more than 12 correct the calcium first due to a risk of calcification
49
When should potassium phosphate be given IV over sodium phosphate
When the patient's potassium is less than 3.5 mEq/L
50
T/F: When PTH is present this stimulates the synethesis of calcitriol
True
51
What drug should be used to lower calcium quickly if the patient is symptomatic
Calcitonin
52
What drug should be used if the patient has longer term hypercalcemia due to malignancy, excessive bone resorption
Bisphosphonates
53
What is the mechanism of action for sensipar (cinclacet)
Decrease PTH by increasing sensitivity of calcium receptor on parathyroid gland
54
What is the biggest culprit for hypophosphatemia
continuous renal replacement therapies, dialysis
55
T/F: If the calcium is greater than 12 mg/dl half the dose of phosphorous
False: If calcium is greater than 12 mg/dl hold on phosphorous because calcification can occur, Half the does if the calcium is between 10.5 to 12
56
T/F: Monitor phosphorous every 6 hours
True

Phar 503 (25 decks)

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