In-House Diagnostics Module 2

Question 1

What are the three factions of total Ca

Answer 1

Ionised calcium (55%) - physiologically active
Complex calcium (10%)
Protein bound calcium (35%)

Question 2

Calcium intake/storage?

Answer 2

Intake mainly via GI tract with excretion via kidneys - Ca stored in bones can be nobilised during hypocalcaemia

Question 3

What hormones are part of calcium control?

Answer 3

1. PTH: main hormone to increase Ca
2. Calcitonin: Decreased Ca by decreased bone absorption
3. Calcitrol: in response to PTHrp, increases Ca by increased GIT absorption and bone resorption

Question 4

7 Causes of hypercalcaemia

Answer 4

1. Neoplasia - multiple myeloma, mammary carcinoma, lymphoma, adenocarcinoma
2. Primary hyperparathyroidism
3. Acute renal failure
4. Idiopathic in cats
5. Granulomatous disease - angiostrongylus, fungal
6. Vit D. tox
7. Bone disorders

Question 5

Clinical signs of hypercalcaemia?

Answer 5

inappetent, lethargy
PUPD
V+, constipation
Affects kidneys ability to respond to ADH - pre-renal azotaemia with dilute urine
soft tissue mineralisation

Question 6

Treatment of hypercalcaemia

Answer 6

• Fluid diuresis - NaCl 4-6ml/kg/hr
• Frusemide 1-2mg/kg q6-12hrs renal Ca excretion
• Bisphosphates (decreased bone resorption) - clondronate
• glucocorticoid at anti-inflam doses
• Salmon calcitonin - possible anaphylaxis
• peritoneal/haemodialysis - life threatening Ca

Question 7

Hypocalcaemia causes?

Answer 7

• Improper sampling
• Hypoparathyroidism - primary/iatrogenic/nutritional
• Chronic renal failure
• Eclampsia
• Ethylene glycol
• Acute pancreatitis
• Malabsorption
• Iatrogenic - rapid blood product admin, rapid phosphate admin, phosphate enema

Question 8

Clinical signs of hypocalcaemia

Answer 8

• Increases excitability of neuromuscular tissue: muscle tremors, facial rubbing, behaviour changes, hyperthermia, panting
  –> tetany, ECG changes, hypotension –> resp distress/death

Question 9

Causes of hypophosphataemia

Answer 9

Decreased GI absorption
Refeeding syndrome
Tumor genesis syndrome
Increased urinary loss - diuresis, hyperaldosterone, glucose therapy

Question 10

Causes of hyperphosphataemia

Answer 10

• most commonly with renal disease
• secondary renal hyperparathyroidism
• tumor lysis syndrome
• rhabdomyolysis
• Haemolysis

Question 11

Types of lactate

Answer 11

Lactate A - shock and decreased systemic perfusion and increased muscular activity
Lactate B - B1: Underlying disease, B2: Drug or toxin induced, B3: mitochondrial myopathy

Question 12

What is urea

Answer 12

an end-product of protein metabolism
synthesised in liver from ammonium and bicarb
excreted via kidneys
affected by urine flow and dehydration

Question 13

What is creatinine

Answer 13

formed in muscle through degradation of creatine and freely filtered through the glomerulus, small amount through Gi tract

Question 14

What are conditions that can trigger DKA

Answer 14

UTI
Acute pancreatitis
Cushings
Cholangiohepatitis
Neoplasia
Renal failure
Infection
GH

Question 15

DKA treatment protocol

Answer 15

1. Restore intravascular volume - match to Na levels
2. K supplementation
3. Insulin/glucose protocol
4. monitor for hypophosphataemia

Question 16

Addisons treatment protocol

Answer 16

fluids - NaCl
K+ tx if needed
Dexameth
Zycortal
Maintenance pred