Lecture 2 - Calcium Flashcards
Calcium
Normal calcium range
8.5-10.5 mg/dL
Calcium Roles
- necessary for ___ formation and neuromuscular function
- serum concentrations are controlled mainly by ___ hormone, vitamin D, and ___
- organs involved in calcium metabolism: bone, kidneys, and the intestine
- bone
- parathyroid, calcitonin
hypocalcemia causes
- more frequently seen in hospitalized pts
- ___ deficiency
- large volumes of ___ products
- hypo___ (must correct Ca)
- post-op hypoparathyroid
- vit D deficiency
- thyroid surgery
- medications
- Mg
- blood
- hypoalbuminemia
when you give a pt blood, citrate (anticoag in blood bag) eats up Ca
calcium correction
Corrected Ca equation
corrected Ca = measured Ca + [(4 - measured albumin) x 0.8]
calcium correction
ionized Ca is more accurate than calculation when available
- ___ mg/dL
- represents amount of calcium available for use in the body
- 4.6-5.1
Clinical Presentation of hypocalcemia
Neuromuscular
- parasthesias, muscle ___, tetany
CNS
- depression, anxiety, memory loss, ___, hallucination, seizures
Dermatologic
- ____ loss, grooved brittle nails, eczema
Cardiac
- prolonged QT, decreased myocardial contractility, arrhythmias, ___, hypotension
- cramps
- confusion
- hair
- bradycardia
acute treatment hypocalemia
100-300 mg ___ Ca IV over 5-10 min
- 1 g Ca chloride = 3 g Ca ___ ( ___ mg elemental Ca)
- ___ can be administed IV push during code
- ___ is preferred for PIV administartion
- gluconate has a ___ percentage of elemental Ca, ___ predictable increase in Ca concentration, less risk for extravasation ( ___ )
- elemental
- gluconate, 270
- chloride
- gluconate
- lower, less, necrosis
acute treatment hypocalemia
- usual administration rate is ___
- do not add ___ or ___ solutions, bc it makes ___
- correct ___
- 1 gm/hr
- bicarb, phos, chalk
- hypomagnesemia
chronic treatment hypocalcemia
PO calcium
- ___ gm/day of ___ Ca
- CaCO3 650 mg PO QID = 1 gm elemental Ca per day
Vit D supplementation
- ___ 0.25 mcg PO daily or every other day
- may need to increase by 0.25 mcg q ___ weeks to 1 mcg PO daily
- 1-3, elemental
- calcitriol
- 4-8
hypercalcemia causes
caused by ___ and primary ___
- increased ___ resorption
- increased GI ___
- decreased elimiation by kidneys
cancer, hyperparathyroidism
- bone
- absorption
hypercalcemia clinical presentation
Often asymptomatic
- especially if serum Ca remains below ___ mg/dL
Depends on the acuity of onset
- acute (malignancy) - anorexia, nausea, vomiting, constipation, polyuria, polydipsia, nocturia
- hypercalcemic crisis (acute Ca > ___ mg/dL) - ARF, obtundation, coma, life-threatening ___
- chronic hypercalcemia - metastatic calcification, nephrolithiasis, ___
- 13
- 15, arrhythmias
- CKD
Hypercalcemia Treatment
- ___ expansion
- ___ diuretics
- calcitonin
- bisphosphonates
- glucocorticoids
- volume
- loop
Hypercalcemia Treatment - volume expansion/loop diuretics
normal to moderately impaired renal function
symptomatic pts are often dehydrated
- __ at rates of 200-300 ml/hr
- ___ (40-80 mg IV q 1-4 hrs), increases uriniary Ca excretion, minimize volume overload
- effective first line option, works within ___ hrs
- NS
- Furosemide
- 4-6
Hypercalcemia Treatment - Calcitonin
- CHF, moderate to severe renal dysfunction
- effective in reducing serum Ca within ___ hrs - inhibits ___ resorption, reduces ___ reabsorption
- SubQ of IM 4 units/kg q 12 hrs, may increase to 8 units/kg
- 12-24, bone, renal tubular
Hypercalcemia treatment - bisphosphonates
- blockade of ___ resorption
- Pamidronate slightly more effective than etidronate
- Pamidronate: ___ mg IV infusion over 2-24 hrs
- Ca concentrations decline within ___ days
- bone
- 30-90
- 2
