Calcium Flashcards
(147 cards)
1
Q
Calcium overload lead to
A
Cell death, mitochondrial pore opening, defective electron transport chain
2
Q
What two way do calcium enter the cell
A
Ligand gated channels, voltage gated channels
3
Q
Ligand gated channels are controlled by
A
Hormones and neurotransmitter
4
Q
Voltage gated channels are controlled by
A
Electric membrane potiental
5
Q
How does Ca exit the cell
A
ATP dependent Ca pump, Na and Ca exchanger
6
Q
What are the two types of Extracellular calcium
A
Diffusible and not diffusible
7
Q
Two types of diffusible Extracellular calcium
A
Free ionized calcium and complex
8
Q
What is the most biologically active calcium
A
Free / ionized calcium
9
Q
What are the functions of free/ ionized calcium
A
Neuron action potiental, muscle contractions, hormone secretion, blood coagulation, intracellular functions
10
Q
Complex Extracellular calcium is
A
Bound to non protein anions
11
Q
Examples of complex calcium
A
Citrate, lactate, phosphate
12
Q
Which calcium is electrically neutral
A
Complexed
13
Q
Which calcium acts a buffer storage pool
A
Protein bound
14
Q
Which calcium is not diffusible
A
Protein bound
15
Q
What must you be measure to calculate total Ca in blood
A
All fractions
16
Q
What must you check when checking total calcium in blood
A
Fasting, non lipemic, non hemolyzed
17
Q
Free calcium is measured as
A
Ionized calcium
18
Q
Where is most calcium
A
99% in bone
19
Q
Where is calcium lost at
A
Gut and kidney
20
Q
Skeleton is storage site for
A
Calcium and phosphorus
21
Q
Major storage form for Ca and P
A
Hydroxyapatite
22
Q
Bone resorption
A
Process osteoclasts break bone and relax minerals in blood stream
23
Q
What can increase osteoclasts activity
A
PTH
24
Q
99% filtered Calcium is absorbed where
A
Proximal tubule
25
PTH dependent reabsorption of Ca happens where
Ascending loop and distal tubule
26
Renal reabsorption
Process by which nephrons remove water and solutes from teh tubular fluid and return them to circulating blood
27
Phos is filtered where
At glomerulus
28
90% P is reaborbed where
Proximal tubule, 10% excreted
29
PTH decreases or increases amount of phs that can be reabsorbed from tubule
Decreases
30
What are the hormones that regulate calcium
PTH, Vitamin D, Calcitonin, PTH related protein
31
PTH regulates
Minute to minute ice
32
PTH secreted by
Parathyroid glands and chief cells
33
PTH can help prevent
Over correction
34
What happens to PTH if there is decreased Calcium
Parathyroid glands will increased PTH in body to increase calcium
35
Increased PTH will do what to calcium
Increased Calcium
36
List the ways that PTH increase Calcium
Calcium resorption in bone, tubular calcium reabsorption, activate calcitrol to increase reabsorption Ca and P in gut
37
If there is an increase in Ca what happen to PTH
Decreases
38
If a patient with hypercalcemia, it is appropriate for PTH to be
Low
39
If a patient with hypercalcemia it is inappropriate for PTH to be
High
40
PTH will increase or decreased P
Decrease
41
PTH will increase or decrease Ca
Increase
42
PTH will increase or decrease calcitrol
Increase
43
Calcitrol is the active form of
Vitamin D3
44
Calcitrol is a fat soluble vitamin obtained from
Diet
45
Calcitrol is activated in
Kidney
46
Calcitrol does what to Ca and Phos
Increases
47
Lesser actions of calcitrol
Increases resorption of Ca and Phos from bone, and increase renal reabsorption Ca and Phs
48
Low calcitrol will stimulate
PTH
49
When you have vitamin D toxicity what do u expect for Ca
High
50
When you have vitamin D toxicity what do you expect for P
High
51
Calcitonin does what
Decrease Ca
52
What is the source of calcitonin
Thyroid gland - parafollicular cells
53
What is cause of humoral hyperCa of malignancy
PTH related protein
54
PTHrP has the same biological function as
PTH
55
If PTH-rp is present this is diagnostic for
Neoplasia
56
Concern if what with Ca and P
Ca x Phos greater than or equal to 60 - 80
57
Concern of Ca and P if
Metastatic mineralization of tissues
58
What will happen to Ca with excessive PTH
Increase
59
What will happen to P if excessive PTH
Decrease
60
What will happen to Ca with not enough PTH
Decrease Ca
61
What will happen with not enough PTH to P
Increase
62
Clinical sings of hypercalcimeia
PUPD and lethargy
63
Na channels with hypercalcemia effects
Harder to depolarization, neuron is less excitable
64
Renal effects of hypercalcemia
Nephrogenic DI, PUPD, Ca-oxalate crystals/stones
65
Hypercalcemia causes the na channels to be
Harder to depolarize and less excitable
66
Renal effects of hypercalcemia
Hypercalciuria
67
What does hyper calciuria cause
Nephrogenic DI, PUPD, crystals or stones
68
How can hypercalcemia cause acute kidney injury
Renal vasoconstriction, worsen with volume depletion
69
What will you aspirate for hypercalcemia
Peripheral lymph nodes, liver/spleen, bone marrow
70
Initial treatment of hypercalcemia
0.9% saline
71
Fluid plan for hypercalcemia
% dehydration, maintenance (PUPD), loses
72
Emergency treatment of hypercalcemia
Fluid diuresis - saline, 2-3x maintenance, K supplement
73
Na will increase what excretion
Ca excretion
74
Filtered Na competes with
Ca for renal tubular respiration
75
Emergency treatment of hypercalcemia - Loop diuretics
Furosemide, Lasix - maximized Na excretion
76
Loop diuretics will decrease
Renal Ca reabsorption
77
Glucocorticoids can cause
Lymphocyte lysis
78
Do not give steroids before
Having ruled out neoplasia
79
How does glucocorticoid decrease Ca
Decrease bone and intestinal absorption and increase renal excretion
80
Bisphosphonates will inhibit
Osteoclasts - inhibit bone resorption
81
IV for ER use bisphosphonates
Zoledronate
82
Onset of Zoledronate
48 hr
83
PO bisphosphonates
Aledronate
84
Bisphosphoantes can do what to the jaw
Cause osteonecrosis
85
Causes of hypercalcemia
HOGS IN YARD
86
4 mechanism of hypercalcemia
Increase PTH, increase calcitrol, unknown, non pathological
87
Hyperparathyroidism is excessive
Secretion of PTH
88
Secondary HPTH is from
Renal or nutritional
89
Primary hyperparathyroidism is from
Abnormal gland produces PTH
90
Most common reason for primary hyperparathyroidism
Adenoma/hyperplasia
91
PHPTH DX
PTH inappropriately increased in the face of hypercalcemia
92
PTH is normal in what percent of dogs
75%
93
PHPTH dogs signalment
Middle to older aged Keeshonds
94
Clinical signs of PHPTH
Asymptomatic, PUPD, lower UT, weakness
95
PHPTH DX from ultrasound neck
On large gland 3 -23 mm
96
PHPTH treatment
Parathyroidectomy
97
What do you monitor post op Parathyroidectomy
Monitor iCa
98
PHPTH Treatment alternatives
Ethanol or heat ablation
99
Secondary HPTH what do you expect to dins
Hypertrophy of all 4 gland
100
In early kidney disease what is the calcitrol
Low levels
101
Late renal disease there is an increase in
Phosphorus
102
What is the PTH and Ca in early renal disease
Increased PTH and decreased CA
103
Clinical consequences of secondary HPTH
Progression of renal disease and bone demineralization
104
TCA can be increased in renal disease due to
Binding of inorganic ions changes and dehydration
105
ICa can be what in renal disease
Increase or decrease or normal
106
Nutritional secondary HPTH - what can be abnormal
Low Ca, Low Vitamin D, Increase Phosphorus
107
What is the most common cause of hypercalcemia in adult dogs
Neoplasia
108
Neoplasia mechanism of hypercalcemia
Humoral hypercalcemia of malignancy and osteolysis
109
Hypervitaminosis D will increase
Ca and P absorption
110
Causes of hyper vitamin D
Vit D rodenticide, anti-psoriasis cream, diet
111
Some clinical features of increase in vitamin D
Acute PUPD, acute renal failure, tissue mineralization
112
Granulomatous disease mechanism
Stimulate macrophages produces calciferol
113
Causes of granulomatous disease
Infections, sterile panniculitis, granulomatous inflammation
114
Most common cause of increase Ca in cats
Idiopathic
115
Clinical signs of high ca in cats - idiopathic
Asymptomatic, GI, constipation, stones
116
Treatment of idiopathic hypercalcemia in cats
1st diet change, increase in fiber and decrease in cats
117
Secondary treatment options for idiopathic increase in calcium in cats
Prednisiolone or PO biphosphates
118
What is the tCA of addition in dogs
Mild increase and normal ice
119
Additions disease is also known as
Hypoadrenocritcism
120
The clinical signs of addisions are not due to
Hypercalcemia
121
Non pathological increase in Ca is found in
Young and growing animals
122
Spurious causes of hypercalcemia
Hemolysis, lipemia
123
With hypocalcemia, the na Channels are more likely to
Open and easier to depolarize and neuron is more excitable
124
Calcium is involved in the release of
Ach during neuromuscular transmission
125
With a decrease in CA there is an increase in
Nervous system excitability
126
Decrease calcium can cause spontaneous
Nerve discharge which leads to muscle contraction n
127
Clinical manifestation of low calcium
Muscle tremors, facial rubbing, restless, seizures, hyproexia weight loss
128
Emergency treatment for hypcalcemia
10% Calcium gluconate IV
129
Maintenance treatment for primary hypoPTHism
Calcitrol and calcium carbonate
130
Disease that cause hypcalcemia
PEEARS
131
PEEARS
Primary hypoPTHism, eclampsia, ethylene glycol toxicity, acute pancreatitis, renal failure, Severe fut disease
132
4 mechanisms of low calcium
Low PTH, low Calcitrol, increase utilization of Ca, or increase calcium consumption
133
Hypoparathyroidism is decreased
Secretion of PTH
134
Primary hypoparathyroidism is
Destruction or atrophy of parathyroid glands - usually immune mediated
135
What does blood look like with primary hypoparathyroidims
Low PTH, Low Ca, normal to increase Phos
136
What does blood look like with primary hypoparathyroidims
Low PTH, Low Ca, normal to increase Phos
137
Primary HypoPTHism is in what signalment
Young , femal dogs
138
Clinical signs of HypoPTHism can worsen with
Excitement , exercise, petting
139
Treatment of primary hypoparathyroidism
Calcitrol
140
Example of decrease gut absorption of Vitamin D
Small intestinal lymphangiectasia
141
SI malabsorption clinical signs
Weight loss, vomiting/diarrhea, actives
142
PLE
Panhypoproteinemia, lymphopenia, hypocholesterolemia, decrease TCA and ice
143
Cannot predict calcium from
TCA
144
Renal disease mechanisms hypocalcemia
Decreased renal activation Calcitrol, hyperphosphatemia, complexed Ca
145
Mechanisms of eclampsia with low Ca
Parathyroid glands unable to response to acute increase in Ca demand, lactating patients
146
Ethylene glycol toxicity
Metabolites of EG chelate Ca into Ca oxylate
147
Acute pancreatitis with hypocalcemia is due to
Precipitation of Ca soaps - saponification of peripancreatic fat
