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sa dx/tx > Disorders of Calcium Homeostasis > Flashcards

Disorders of Calcium Homeostasis Flashcards

1
Q

Where is the majority of the bodys calcium?

A

Bone

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2
Q

What does PTH do?

A

Raise serum calcium levels
Activates osteoclasts
Promotes calcium reabsorption

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3
Q

What is Vitamin D essential for?

A

GI uptake of calcium

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4
Q

What does Calcitonin do?

A

Lower serum calcium levels
Inhibits osteoclasts
Inhibits calcium reabsorption

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5
Q

What do osteoclasts do?

A

Release stored calcium
Part of the macrophage family

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6
Q

What is ionized calcium (iCa)?

A

The metabolically active portion
Defines true hypo- or hypercalcemia

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7
Q

What is protein bound calcium?

A

Mostly bound to albumin
Influenced by acid-base status

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8
Q

What defines true hyper- or hypo-calcemia?

A

Ionized calcium

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9
Q

What are the three mechanisms for hypercalcemia?

A

Excessive vitamin D activity
Excessive PTH activity
Excessive direct osteolytic activity

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10
Q

What are the most common differentials for canine hypercalcemia?

A

TUMORS
Drugs
Hyperparathyroidism
Granulomatous

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11
Q

What are the most common differentials for feline hypercalcemia?

A

IDIOPATHIC
Tumors
Renal
Hyperparathyroidism
Spurious

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12
Q

What are the three common presentations for hypercalcemia patients?

A

They come in sick from their underlying disease
They come in with signs reflecting increased calcium
You stumble across hypercalcemia during a wellness visit (cats)

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13
Q

What is the most common sign of hypercalcemia in the canine patient?

A

PU/PD

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14
Q

What is the most common sign of hypercalcemia in the feline patient?

A

ADR or dysuria from urolithiasis

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15
Q

When would you expect to see tissue mineralization?

A

Calcium x Phosphorus > 70

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16
Q

What would you expect to see with mild hypercalcemia (tCa < 13 mg/dl)?

A

Compromised ability to concentrate urine (dogs)
Increased risk of urolithiasis from calcium oxalate stone formation
GI issues (primarily cats)

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17
Q

What would you expect to see with moderate hypercalcemia (tCa 13-15 mg/dl)?

A

Mild signs
Renal damage (depending on phosphorus)
Possibly triggers pancreatitis (dogs)
Personality change

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18
Q

What would you expect to see with severe hypercalcemia (tCa > 15 mg/dl)?

A

Decreased neuromuscular excitability
Cardiac arrhythmias

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19
Q

What is the most common cause of hypercalcemia in dogs?

A

Hypercalcemia of malignancy / humoral hypercalcemia

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20
Q

What are the most common types of tumors causing hypercalcemia in dogs?

A

Lymphoma
AGASACA

21
Q

What is the common mechanism of tumors causing hypercalcemia?

A

Release of PTH-rp causing increased calcium

22
Q

How would you diagnose hypercalcemia of malignancy?

A

Measurement of PTH-rp
Positive = very strongly supports a tumor, has been positive in dogs with Heterobilharzia
Negative = does not rule out malignancy

23
Q

What is primary hyperparathyroidism usually due to?

A

A solitary adenoma

24
Q

How would you diagnose primary hyperparathyroidism?

A

Measure serum PTH concentrations
May be above the upper limit of the reference range or may be in the upper end of the range
Interpret in the light of concurrent iCa levels
Inappropriate in the face of hypercalcemia

25
Q

What is treatment for primary hyperparathyroidism?

A

Surgical removal of the affected gland
Ethanol ablation
Radiothermal ablation
Patient will need calcitriol +/- calcium until other gland wakes up

26
Q

What would you expect to see with hypercalcemia associated with renal disease?

A

tCa often elevated with renal disease, but iCa is normal
CKD results in secondary hyperparathyroidism
Some individuals have autonomous parathyroid glands eventually causing PTH to be secreted inappropriately

27
Q

How would you diagnose and treat Vitamin D toxicity?

A

Measure Vitamin D levels
Fluid therapy
Glucocorticoids

28
Q

What is idiopathic hypercalcemia linked to?

A

Acidifying diets

29
Q

How would you diagnose idiopathic hypercalcemia?

A

Diagnosis of exclusion

30
Q

What would you expect the calcium to be in idiopathic hypercalcemia?

A

tCa usually <13 mg/dl, usually mild

31
Q

When should you not give glucocorticoids?

A

If you do not have a diagnosis
Will hide lymphoma
Will let fungal disease run rampant

32
Q

What should you be careful with when giving Alendronate in cats with idiopathic hypercalcemia?

A

Substantial risk of esophagitis
Must be given on an empty stomach

33
Q

What does low phosphorus suggest?

A

A PTH type mechanism
Tumor is most likely
Heterobilharzia
Primary hyperparathyroidism

34
Q

What does a normal phosphorus suggest?

A

Direct osteolysis or low-grade Vitamin D mechanism
Osteosarcoma
Osteomyelitis
Idiopathic hypercalcemia

35
Q

What does a high phosphorus with minimal azotemia suggest?

A

Vitamin D mechanism
Diets
Vitamin D toxicity

36
Q

What does a high phosphorus with substantial azotemia suggest?

A

Harder to figure out
Addisons
Vitamin D toxicity
Renal damage/disease

37
Q

When should you intervene with hypercalcemia?

A

tCa > 15 mg/dl
Calcium is rising fast
Ca x Phos > 70
Hypercalcemia and quickly progressive azotemia

38
Q

What should you give first in a hypercalcemic patient?

A

0.9% NaCl fluids (or NormR)

39
Q

What are the three mechanisms for hypocalcemia?

A

Inadequate intake of Vitamin D or calcium
Inadequate parathyroid
Overwhelming acute demand for calcium

40
Q

What are the main clinical signs of hypocalcemia?

A

Neuromuscular!!
Facial rubbing
Tremors
Hypersensitivity
Tetanic seizures
Respiratory arrest
Behavioral changes

41
Q

How would you diagnose and treat primary hypoparathyroidism?

A

Measure PTH concentrations - will be subnormal or in the lower end of reference range
Treat with Calcitriol long term and calcium short term

42
Q

What types of diets are more prone to cause dietary imbalance of hypocalcemia?

A

Homemade diet
All meat diets are calcium and vitamin D deficient

43
Q

When does puerperal tetany occur?

A

1-3 weeks post partum

44
Q

What is puerperal tetany due to?

A

Loss of calcium into milk

45
Q

What type of dogs are most vulnerable for puerperal tetany?

A

Small breed dog with large litter

46
Q

How would you treat puerperal tetany?

A

Calcium gluconate IV
Avoid noise and excitement

47
Q

How would you manage the emergent hypocalcemic?

A

Calcium gluconate
0.5-1.5 ml/kg of 10% given IV over 30 mins - need concurrent ECG monitoring
6-10 ml/kg/day as CRI until stabile

48
Q

Why should you use caution with calcium chloride?

A

Very caustic if extravasated

sa dx/tx (26 decks)

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