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Endocrinology > Calcium > Flashcards

Flashcards in Calcium Deck (22):
1

Hypercalcemia

  • Total serum Ca > 12 mg/dl OR ionized Ca > 1.42 mmol/L

2

Primary Hyperparathyroidism

  • Inc PTH from parathyroid
    • inc Ca
    • dec P
  • Once kidneys get wiped out P will inc

3

hypervitaminosis D

  • Over supplementation or rat poison
  • Inc Ca, Inc P

4

fungal dz causing hypercalcemia

  1. blastomycosis
  2. histoplasmosis

5

Causes of Hypercalcemia

  • Hypercalcemia of malignancy => lymphoma and anal sac carcinoma
  • Primary hyperparathyroidism
  • Osteolytic metastasis => carcinomas and multiplemyelomas
  • Hyper vit D
  • Day-blooming Jessamine ingestion
  • 2 renal hyperPTH
  • Addison's dz - not sig
  • Granulomatous dz
  • Idiopathic in some cats => treat with pred

6

secondary renal hyperparathyroidism

  • Kidneys become insufficient and P rises
  • Rising P meets threshold and chelates free Ca
  • Lower free Ca in blood increases PTH release => hyperCa

7

Signs of hypercalcemia

  • anorexia
  • vomiting
  • depression
  • weakness
  • PU/PD
  • Dehydration
  • abdominal discomfort
  • constipation
  • urinary calculi

8

kidney calcification

not reversible

9

Hypercalcemia workup

  • Thorough HX and PE incl RECTAL
  • Hemogram
  • Serum chemistry panel
  • UA
  • Chest/abdominal rads

10

Hypercalcemia

Other DX tests

  • Bone marrow aspirate - myeloma and other tumors
  • FNA of growths - granuloma/tumor
  • Plasma PTH - primary hyperPTH
  • PTH related peptide - cancer
  • Serum EPH - myeloma
  • Bence - Jones - myeloma

11

PTH tumors

  • Benign tumor more common than the malignant tumor

12

Causes

Inc Ca2+ in Malignancy

  • PTH
  • Protein related-like PTH
  • Osteoclast activating factor
  • Vitamin D-like compounds
    • granulomas

13

NOT EVERY ANAL SAC CARCINOMA CAUSES ________

Hypercalcemia

14

TX hypercalcemia

General guidelines

  • correct dehydration (0.9 saline for calciuresis)
    • LRS has less sodium
  • Promotes calciuresis
  • Inhibit bone reabsorption
  • Treat uderlying disorder

Specific drugs

  • NaCl IV
  • Glucocorticoids
    • take blood sample first b/c steroids cause lymphocytolysis
  • Bisphosphonates IV
    • inhibits peripheral osteoclast activity
  • Thyrocalcitonin
    • works opposite of PTH
  • Plicamycin
    • not used much, anti-cancer
  • NaHCO3
    • not used much.....

*Furosemide no longer used

15

TX vit D intoxication

  • Glucocorticoids => antagonize Vit D
  • IV saline
  • +/- Calcitonin

16

Hypercalcemia

Take home message

  • Signs: PU/PD, lethargy, poor appetite; neurologic (get quiet...?)
  • Common causes: paraneoplastic, primary inc PTH
  • Nephrocalcinosis is a serious consequence (chronic irreversible dz)
  • Primary TX: rehydrate with 0.9% saline

17

Hypocalcemia

  • total serum Ca2+ < 9.0 mg/dl OR < 1.12 mmo/L

18

Hypocalcemia causes

  • Primary HypoPTH (immune mediated hypoendocrinopathy)
    • low Ca and high P
  • Postpartum lactation
  • Hypophosphatemia (acute)
  • Hypovitamin D
  • Hypoalbuminemia
  • Acute hyperphosphatemia

19

Hypocalcemia CS

  • neuromuscular irritability
    • Tetany
    • Convulsion
    • Marked weakness (bovine)

20

Fleet Enema syndrome

  • Fleet enemas contain high P and high Na
  • Obstipation causes absorption of P
    • Inc P breaches threshold and precipitates Ca
    • Can happen in 15-20 minutes
    • Causes hypocalcemic crisis => seizure

21

Eclampsia

Postparturient hypocalcemia

  • usually several days postpartum
  • usually smaller dogs
  • restlessness, panting, nueromuscular irritability
    • easy to ID without chemistries
    • Cagluconate IV => easy to hit these veins!
      • CaCl more bioavailable, use less and make sure in vein!
    • look out for hypoglycemia....?

22

Hypocalcemia

Take home messages 

  • Muscle weakness, tetany, seizures
  • Main causes
    • 1 HypoPTH, Inc P, eclampsia
  • TX
    • Ca gluconate
  • Chronic TX
    • DHT, Oral Ca, Calcitriol