Calcium disorders Flashcards

(39 cards)

1
Q

what should you check if we see a low total calcium

A

check for hypoalbuminaemia

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2
Q

If we see high total calcium what should we check

A

phosphate levels

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3
Q

What will happen if both calcium and phosphorous high in blood

A

will complex/precipitate
in tissues= mineralisation
this can affect the structure of some organs- and therefore their function

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4
Q

List 6 mechanisms of hypercalcaemia

A

Increased PTH activity
Activity of PTH-like substances- neoplasia
Increased Vitamin D activity
Osteolysis
Other/unclear mechanism:
- Hypoadrenocorticism
- Feline idiopathic hypercalcaemia
- Raisin toxicity

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5
Q

List the 6 most common causes of total hypercalcaemia in dogs

A
  1. Malignancy
  2. Hypoadrenocorticism
  3. Primary hyperparathyroidism
  4. Chronic renal failure
  5. Vitamin D toxicosis
  6. Granulomatous diseases
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6
Q

List the 4 most common causes of total hypercalcaemia in cats

A
  1. Idiopathic hypercalcaemia
  2. Renal failure (total mainly, occ iCa)
  3. Malignancy (lymphoma and squamous cell carcinoma)
  4. Primary hyperparathyroidism
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7
Q

what age does idiopathic hypercalcaemia affect

A

youn to middle aged cats

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8
Q

What are the signs of hypercalcaemia

A

PU/PD
vomiting
anorexia
muscle weakness
dehydration

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9
Q

what age does primary hyperparathyroidism generally affect

A

middle aged to geriatric disease

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10
Q

If we see hign serum ionised Ca and high serum parathyroid hormone what do we suspect

A

primary hyperparathyroidism

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11
Q

If we see hig hserum ionised Ca and low serum parathyroid hormone what do we suspect

A

PTH independent hypercalcaemia (e.e. malignancy, vitamin D toxicity

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12
Q

What is measuring 25 hydroxy vitamin D good indicator of

A

Excellent indicator of dietary sufficiency and excess
BUT
Will not detect vit D analogues

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13
Q

Describe the generic treatment for hypercalcaemia

A

Determine urgency by Ca x P
Fluids/diuresis- NaCl and frusomide
Glucocorticoids
Bisphosphanates

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14
Q

Describe the effects of vitamin D on calcium in the body

A

causes the liver to produce calcidiol, which is turned into calcitriol in the kidneys-which increases Ca absorption from tubules

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15
Q

Describe the effects of PTH on calcium levels

A

PTH increases calcium turnover in the bone and stimulates the kidneys to release calcitriol, as well as stimulating the kidneys to decrease calcium clearance

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16
Q

what is the function of calcitriol

A

causes an increase in calcium uptake in gut

17
Q

If you get hypercalcaemia, what do you need to check

A

if your patient is abnormal or is your sample abnormal

18
Q

why is total calcium not as reliable as ionised calcium levels

A

total calcium can be affected by other things

19
Q

How does low albumin levels affect toatl calcium values in blood

A

it will cause a low calcium, as there will be less bound calcium

20
Q

Describe how phosphorous affects total calcium values

A

higher phosphate will mean more calcium binding- this creates an increased complexed fraction of calcium
the body responds by increasing PTH due to low ionized calcium- this creates high calcium level

21
Q

Describe how renal secondary hyperparathyroidism occurs

A

FGF-23 lowers and this causes decreased calcitriol and reduced calcium absorption, this causes an increased PTH

22
Q

List 7 causes of vitamin D excess

A

over-supplementation
incorrect dietary formulation
rodenticide
vitamin D analogues
plants
granulomatous disease
immunological

23
Q

Describe how hypoadrenocorticism cause hypercalcaemia

A

The exact mechanism is unknown -but it is suspected that dehydration and an increased protein concentration, combined with decreased renal excretion

24
Q

What parasite can cause hypercalcaemia in dogs

A

Angiostrongylus

25
how can we diagnose a hypercalcaemia caused by PTH on clinical pathology
there will be high calcium and low phosphorous OR measure PTH levels
26
if we have azotaemia and hypercalcaemia, how can we tell which one came first
renal dysfunction will have an elevated total calcium but a low ionized calcium if calcium has caused renal dysfunction, then the ionized calcium will be high as well as the total calcium
27
What is ionized calcium levels like in secondary hyperparathyroidism
low-normal
28
what are ionised calcium levels like in primary hyperparathyroidism
high
29
What is PTHrP
Parathyroid hormone-related protein produced in malignant hypercalcaemia cases
30
where is 25 hydroxy vitamin D produced
in the liver
31
why would we test calcidiol levels
to look for vitamin D toxicity
32
why would we test calcitriol levels
to look for renal disease or secondary hyperparathyroidism
33
why do we give glucocorticoids to hypercalcaemic patients
some tumours may be steroid sensitive glucocorticoids also promotes calcium losses
34
why do we give bisphosphanates to hypercalcaemic patients
stops calcium being taken out of bone
35
why do we have to be careful when removing parathyroid adenomas
all other PTH tissues will be atrophied - the animal won't have enough PTH of its own and we can get a post surgical hypocalcaemia
36
what do we have to give post parathyroid adenoma removal
IV calcium and vitamin D therapy
37
List the 3 categories of hypocalcaemia
parathyroid dependent (primary hypoparathyroidism), demand exceeds supply or mobilisation, PTH and calcitriol resistance syndromes
38
List 10 clinical signs of hypocalcaemia
muscle fasciculation/tremors face rubbing biting/licking paws hypersensitivity stiff gait ataxia tetanic seizures respiratory arrest weakness behavioural changes
39
Describe how to treat hypocalcaemia
IV calcium- monitor for bradycardia oral calcium and vit D for long term