Calcium Flashcards
(44 cards)
Normal serum calcium
8.5-10.5mg/dL
Normal serum calcium
8.5-10.5mg/dL
normal ionized calcium
1.12-1.3 mmol/L
laboratory hypocalcemia
hypoalbinemia causes serum calcium to appear lower; get an ionized calcium or corrected calcium
corrected calcium
corrected= serum Ca + 0.8(4-measured albumin)
raise Ca levels
PTH and vitamin D
lower Ca levels
calcitonin
HYPOcalcemia
causes of HYPOcalcemia
vitamin D deficiency, hypoparathyroidism, hypoalbuminemia, hypomagnesemia, hyperphosphatemia, loop diuretics, oral PO4, anticonvulsants
symptoms of HYPOcalcemia
neuromuscular–tetany and cramps, cardiovascular–ECG changes and decreased myocardial contraction, depression, confusion, memory loss, anxiety, seizures, hair loss, brittle nails, eczema
treatment for symptomatic HYPOcalcemia
IV calcium chloride 1g or gluconate 2-3g over 5-10 minutes central line; gluconate pref for peripheral line
treatment for asymptomatic HYPOcalcemia
oral calcium 1-3 grams/day; range for maintenance dose is 2-8 g/day
Ca gluconate
9% elemental calcium
Ca chloride
27% elemental calcium
oral Ca carbonate
40% elemental calcium
oral Ca citrate
21% elemental calcium
HYPERcalcemia
> 10.5 serum; usually caused by cancer, hyperparathyroidism, thiazides, lithium, adrenal insufficiency, hyperthyroidism
Mil/Moderate HYPERcalcemia
HYPERcalcemic crisis
> 15, acute renal insufficiency, obtundation, TREAT AGGRESSIVELY
cornerstone management for acute HYPERcalcemia
IV saline rehydration–> 200-300mL/hr NS and consider a loop diuretic to promote calcium excretion (ie. Furosemide 40-80mg IV q1-4h)
treatment for severe HYPERcalcemia >14
Calcitonin–most rapid decrease; can be combined with saline and or bicarbonate
bisphosphonates
tmt for HYPERcalcemia; first line for cancer associated; 2 day onset; Zoledronate, pamidronate, etidronate, ibandronate
glucocorticoids
tmt for HYPERcalcemia; reduce GI absorption, increase urinary excretion, decrease bone resorption; 3-5 days to reduce calcium; immunosuppression
normal ionized calcium
1.12-1.3 mmol/L
