Hypercalcemia- NOT FINISHING SINCE ONLY 1 ?

Question 1

What is the equation for corrected calcium?

Answer 1

(0.8 (Normal Albumin - Patients Albumin)) + Stem, and serum Ca

Question 2

What is an essential intracellular and extracellular cation?

Answer 2

Calcium

Question 3

What is extracellular calcium required to maintain?

Answer 3

Normal biological function of the nervous system, the MSK system and blood coagulation

Question 4

What is intracellular calcium needed for?

Answer 4

Normal activity of many enzymes

Question 5

In general what 4 things is calcium needed for?

Answer 5

1. Preservation of the integrity of cellular membrane
2. Regulation of endrocrine and exocrine secretory activities
3. Activation of complement system
4. Bone metabolism

Question 6

What do respiratory alkalosis and elevated pH cause?

Answer 6

Increase in the binding of calcium and lowers ionized calcium

Question 7

What does respiratory acidosis and decreased pH cause?

Answer 7

Decrease in the binding of calcium and increases ionized calcium

Question 8

A shift of 0.1pH unit produces a change in ionized calcium of what?

Answer 8

0.04 to 0.05 mmol/L

Question 9

What can transiently decrease ionized calcium?

Answer 9

Chelators like citrate

Question 10

What is total body Ca?

Answer 10

1-1.5kG

Question 11

Where is body Ca?

Answer 11

99% in skeleton, 0.1% in ECF, rest is intracellular

Question 12

One gram per deciliter of albumin binds approximately how many mg/dL of calcium?

Answer 12

0.8

Question 13

What are some GI manifestations of hypercalcemia?

Answer 13

Anorexia, nausea, vomiting, constipation, rarely acute pancreatitis

Question 14

What are some CVS manifestations of hypercalcemia?

Answer 14

HTN, shortened QT interval, enhanced sensitivity to digitalis

Question 15

What are some renal manifestations of hypercalcemia?

Answer 15

Polyuria, polydipsia, and occasionally nephrocalcinosis

Question 16

What are some CNS manifestations of hypercalcemia?

Answer 16

Cognitive difficulties, apathy, drowsiness, obtundation, or even coma

Question 17

What is the most common symptom of hypercalcemia?

Answer 17

Nocturia

Question 18

What are 3 signs of hypercalcemia?

Answer 18

1. Bony tenderness
2. Hyperactive tendon reflexes
3. Tongue fasiculations

Question 19

What can hypercalcemia in a pregnant female cause?

Answer 19

Hypocalcemia in the neonate (by suppressing the fetal PTH)

Question 20

What can hypercalcemia do to the kidneys?

Answer 20

Cause a small decrease in GFR (d/t hemodynamic effects and hyposthenuria- loss of renal concentrating abilities)

Question 21

What are some complications of hypercalcemia?

Answer 21

1. Sinus bradycardia
2. Increase in the degree of a heart block
3. Cardiac arrhythmia
4. HTN
5. Pancreatitis
6. PUD
7. Nephrolithiasis
8. Accelerated vascular calcification

Question 22

What are the 3 hormones and 3 organs involved in calcium homeostasis?

Answer 22

PTH, Vitamin D, Calcitonin

Bone, kidney, small intestine

Question 23

In PTH cells, what is adjusted according to physiological demand?

Answer 23

Hormone degradation (rather than synthesis- this is unusual)

Question 24

How much PTH can be destroyed within the chief cells?

Answer 24

90%

Question 25

What stimulates PTH secretion?

Answer 25

Blood levels of calcium drop by as little as 0.1mg/dL

Question 26

What is the half life of PTH?

Answer 26

Minutes

-Kidney reacts quickly to changes in PTH and is responsible for minute to minute adjustments of blood calcium

Question 27

Where does PTH act in the nephron to decrease urinary excretion of calcium mediated by cAMP?

Answer 27

Distal portion of the nephron