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PHRM 825 > PHRM 825: Fluids and Electrolytes - Electrolytes - Ca+2 > Flashcards

PHRM 825: Fluids and Electrolytes - Electrolytes - Ca+2 Flashcards

1
Q

Normal Ca+2 blood levels

A

8.5-10.5 mg/dL

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2
Q

Calcium is necessary for ____ formation and _____ funciton

A

bone and neuromuscular

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3
Q

Calcium serum concentrations are controlled mainly by what 3 things?

A

parathyroid hormone, vitamin D, and calcitonin

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4
Q

Organs involved in calcium metabolism include

A

bone, kidneys, and the intestine

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5
Q

Causes of hypocalcemia (7)

A
  • Magnesium deficiency
  • Large volumes of blood products
  • Hypoalbuminemia
  • Post-op hypoparathyroid
  • Vitamin D deficiency
  • Thyroid surgery
  • Medications
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6
Q

Hypocalcemia is typically seen in what kinds of patients?

A

Hospital patients

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7
Q

Corrected calcium equation

A

Corrected Ca+2 = measured Ca+2 + [(4 - measured albumin) x 0.8]

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8
Q

When available, you should use the _____ over the corrected calcium calculation

A

ionized calcium level

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9
Q

Normal ionized calcium levels

A

4.6-5.1 mg/dL (milligram, NOT milliequivalents)

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10
Q

What does ionized calcium levels represent?

A

The amount of calcium available for use in the body

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11
Q

Clinical presentation of hypocalcemia in the neuromuscular system

A
  • Parasthesias
  • Muscle cramps
  • Tetany
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12
Q

Clinical presentation of hypocalcemia in the CNS

A
  • Depression
  • anxiety
  • Memory loss
  • Confusion
  • Hallucination
  • Seizures
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13
Q

Clinical presentation of hypocalcemia in the dermatologic system

A
  • Hair loss
  • Grooved brittle nails
  • Eczema
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14
Q

Clinical presentation of hypocalcemia in the cardiac system

A 
-Prolonged QT
Decreased myocardial contractility
-Arrhythmias
-Bradycardia
-Hypotension
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15
Q

Acute treatment of hypocalcemia

A
  • 100-300 mg of elemental Ca+2 IV oer 5-10 minutes
  • Usual administration rate for Ca+2 is 1 gm/hr
  • Correct hypomagnesemia
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16
Q

What should you NEVER give a patient when giving calcium to treat hypocalcemia?

A

Bicarb or phos solutions (It will precipitate and create chalk in the bloodstream)

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17
Q

1 g CaCl = ____ g Ca gluconate

A

3

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18
Q

1 g CaCl= ____ mg elemental calcium

A

270

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19
Q

3 g Ca gluconate = ____ mg elemental calcium

A

270

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20
Q

Calcium chloride can be administered PIV when?

A

During a code (cardiac arrest)

21
Q

Calcium gluconate is preferred for ____

A

PIV administration

22
Q

What aspects of calcium gluconate make it preferred for PIV administration

A
  • Lower percentage of elemental Ca+2
  • Less predictable increase in Ca+2 concentration
  • Less risk for extravasation
23
Q

Chronic treatment of hypocalcemia

A
  • PO calcium

- Vitamin D supplementation

24
Q

PO calcium treatment for hypocalcemia

A

-1-3 g/day of elemental Ca+2

25
Q

1 g elemental Ca+/day is equivalent to _____ of CaCO3

A

650 mg PO QID

26
Q

Vitamin D supplementation for hypocalcemia

A
  • Calcitriol 0.25 mcg PO daily or every other day

- May need to increase by 0.25 mcg q 4-8 weeks to 1 mcg PO daily

27
Q

Hypercalcemia is typically present in what 2 disease states?

A

Cancer and hyperparathyroidism

28
Q

3 mechanisms that lead to hypercalcemia

A
  • Increased bone resorption
  • Increased gastrointestinal absorption
  • Decreased elimination by the kidneys
29
Q

Hypercalcemia is often ____ especially when serum calcium is ____

A

asymptomatic; <13 mg/dL

30
Q

Clinical presentation of acute onset of hypercalcemia

A
  • Anorexia
  • Nausea
  • Vomiting
  • Constipation
  • Polyuria
  • Polydipsia
  • Nocturia
31
Q

Clinical presentation of hypercalcemic crisis

A
  • ARF
  • Obtundation
  • Coma
  • Life-threateing arrhythmias
32
Q

Hypercalcemic crisis is characterized by calcium concentration of ___

A

> 15 mg/dL

33
Q

Clinical presentation of chronic hypercalcemia

A
  • Metastatic calcification
  • Nephrolithiasis
  • CRF
34
Q

Goals of treatment for hypercalcemia

A
  • Reverse signs and symptoms
  • Restore to normal calcium concentrations
  • Identify and treat the underlying cause(s)
  • Prevent long term consequences, renal insufficiency
35
Q

Treatments for hypercalcemia

A
  • Volume expansion/loop diuretics
  • Calcitonin
  • Bisphosphonates
  • Glucocorticoids
36
Q

Volume expansion/Loop diuretics should be used to treat hypercalcemia when renal function is ____

A

normal to moderately impaired

37
Q

Volume expansion/loop diuretics should be used in ____ patients that have ____

A

symptomatic patients; hypercalcemia

38
Q

In hypercalcemia, symptomatic patients are often _____ because of ___

A

dehydrated; vomiting/ polyuria

39
Q

When administering NS to treat _____, you should monitor ____

A

hypercalcemia; ins and outs or CVP

40
Q

How does furosemide help treat hypercalcemia

A
  • Increases Ca+ urinary excretion

- Minimizes volume overload

41
Q

Calcitonin should be used to treat _____ in patients with _____

A

hypercalcemia; moderate to severe renal dysfunction or CHF

42
Q

Calcitonin _____ serum Ca+2 by ____

A

reduces; inhibiting bone resorption and reducing renal tubular reabsorption

43
Q

How do bisphosphonates help treat hypercalcemia

A

Prevent bone reabsorption

44
Q

_____ bisphosphonate is more effective at reducing Ca+2 levels than ____ bisphosphonate

A

Pamidronate; etidronate

45
Q

Bisphosphonates cause Ca+2 concentrations to decline in ____ days

A

~2

46
Q

Glucocorticoids can be used to treat hypercalcemia in patients caused by

A
  • Multiple myeloma
  • Leukemia
  • Lymphoma
  • Sarcidosis
47
Q

How do glucocorticoids treat hypercalcemia

A
  • Decrease GI absorption

- Interfere with vitamin D metabolism (increases bone resorption and decreased osteoblast proliferation)

48
Q

Glucocorticoids have a ____ onset and increase the risk of ____ or _____

A

Onset; hyperglycemia or infection

PHRM 825 (36 decks)

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