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Flashcards in 5a Deck (110)
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61

what mineral should be checked with refractory hypoK and hypoCa

magnesium

62

EKG changes of hyperK

spiked T waveprolonged PR intervalbradycardiawidened QRSdisappearance of P wavesV fib/asystole

63

general clinical signs of hypoK

< 3 muscle weakness, arrythmias2 rhabdomyolysis<2 respiratory muscle paralysis

64

classical clinical signs of hypoK in cats

cervical ventroflexionstiff stilted gaithindlimb weaknessplantigrade stance

65

what effect does low K have on pancreatic islet cells

low K impairs insulin release from beta pancreatic cells

66

treatment of hypo K

K supplementationKCl or KPhosDO NOT EXCEED 0.5 mEq/kg/hr

67

causes of hyperK

decreased renal excretion (obstruction, uroab, oligo/anuric renal fail)GI dz--whipwormsChylothoraxdrugs (ACE inhibits, NSAIDS, K sparing diuretics, heparin)Translocation (acidosis, tumor lysis syndrome)increased intakePseudohyperKAddisons

68

define pseudo hyper K

occurs as a result of severely elevated WBC (>100,000)hemolysis ( ESS, Akitas--with hi IC K)thrombocytosis

69

most common cause of hyper K

impaired renal excretion

70

what syndrome occurs if serum Na increases too fast

central pontine myelinosis(demyelination)

71

T/F Boag JVIM 2005linear FB (not discrete FB) were associated with low Na, Low Cl and metabolic alkalosis

Truelinear FB (not discrete FB) were associated with low Na, Low Cl and metabolic alkalosis

72

most clinically relevant adverse effect of hyper K

decrease in RMP (makes it more negative)more negative (less than threshold potential)therefor cannot depolarize

73

tx hyper K

K deficient fluidsCa gluconate (0.5-1 ml/kg SLOWLY)Dextrose/InsulinCatecholamines --Beta2 agonist (albuterol)Na bicarbHemodialysis

74

Mx of calcium gluconate for treatment of hyperK

does not alter K levelsraises threshold membrane potential to restore cell excitability

75

where is 99% of Ca found

hydroxyapatite of bone

76

forms of calcium and which is most active

ionized, protein bound, chelatedionized is most active; doesn't always correlate w other forms

77

T/Fhypoalbuminemia affects total body Ca levels

true but NOT active ionized form

78

three hormones regulating Ca homeostasis

calcitonin--senses hi Ca, GOAL to lower Cavitamin D (cholecalciferol)--aims to incr Caparathyroid hormone--senses low Ca. GOAL to incr Ca

79

3 body systems involved in Ca homeostasis

boneGIkidney

80

PTH ROLE

senses low Caincr Ca from bone, incr resorption from kidneyactivates vit D from kidney (incr Ca absorption from gut)

81

Calcitonin role

senses hi Ca, GOAL to lower Cainhibits bone resorption and release of Ca

82

causes of hypoCa

decr PTH release ( hypoPTH, postopthyroidectomy/PTectomy, suppression from chronic hyperCa, hypoMg)decr vit D (renal failure, malabsorption, liver insufficiency)Chelation (eclampsia, UT obstruction, saponification-pancreatitis, anticoag in blood transfusions, ethylene glycol))Critical illnesshypoAlb (does not change ionized, only total)

83

mechanism of acute/chronic renal failure on bit D synthesis

renal failure decreases the ability of kidney to convert25-hydroxycholecalciferol to to vit D (cholecaciferol)

84

clinical signs of hypoCa

muscle tremors, hyperexcitability, restless, facial rubbing, stiff, seizures, hyperthermia, vomiting

85

tx hypoCa

calcium gluconate 0.5-1.0 ml/kg slowly 10-20 minwatch ECG for bradyarrythmias

86

causes of hyper Ca

G (granulomatous dz)O (osteoclastic dz/osteomyelitis/osteoporosis)S (spurious)H (hyperPTH--primary or secondary)D (vit D toxicosis--cholecalciferol toxicosis)A (Addisons)R (renal failure)N (neoplasia--AGAC, lymphoma, MM, mets--carcinomas; nurtritional secondary renal hyperPTH)I (iatrogenic, idiopathic)T (toxins)

87

how does malignancy lead to hyper Ca

paraneoplastic syndromelymphoma, anal sac adenocarcinomaPTH-related peptide synthesismost common cause of hyper Ca in DOGS

88

most common cause of hyper Ca in cats

IDIOPATHIC

89

tx of hyperCa

Ca free fluids---NaCl diuresisloop diuretic--promotes calciuresis furosemideGCCBisphosphonatesCalcitoninCa channel blockersNabicarbdecr calcium in diet

90

Magnesium plays an important role in what homeostatic mechanism

PTH and vitamin D maintenance of Ca levelsif low Mg PTH does not work normally