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SA dx/tx > Disorders of Calcium Homeostasis > Flashcards

Disorders of Calcium Homeostasis Flashcards

(48 cards)

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1
Q

Where is the majority of the bodys calcium?

A

Bone

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2
Q

What does PTH do?

A

Raise serum calcium levels
Activates osteoclasts
Promotes calcium reabsorption

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3
Q

What is Vitamin D essential for?

A

GI uptake of calcium

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4
Q

What does Calcitonin do?

A

Lower serum calcium levels
Inhibits osteoclasts
Inhibits calcium reabsorption

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5
Q

What do osteoclasts do?

A

Release stored calcium
Part of the macrophage family

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6
Q

What is ionized calcium (iCa)?

A

The metabolically active portion
Defines true hypo- or hypercalcemia

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7
Q

What is protein bound calcium?

A

Mostly bound to albumin
Influenced by acid-base status

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8
Q

What defines true hyper- or hypo-calcemia?

A

Ionized calcium

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9
Q

What are the three mechanisms for hypercalcemia?

A

Excessive vitamin D activity
Excessive PTH activity
Excessive direct osteolytic activity

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10
Q

What are the most common differentials for canine hypercalcemia?

A

TUMORS
Drugs
Hyperparathyroidism
Granulomatous

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11
Q

What are the most common differentials for feline hypercalcemia?

A

IDIOPATHIC
Tumors
Renal
Hyperparathyroidism
Spurious

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12
Q

What are the three common presentations for hypercalcemia patients?

A

They come in sick from their underlying disease
They come in with signs reflecting increased calcium
You stumble across hypercalcemia during a wellness visit (cats)

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13
Q

What is the most common sign of hypercalcemia in the canine patient?

A

PU/PD

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14
Q

What is the most common sign of hypercalcemia in the feline patient?

A

ADR or dysuria from urolithiasis

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15
Q

When would you expect to see tissue mineralization?

A

Calcium x Phosphorus > 70

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16
Q

What would you expect to see with mild hypercalcemia (tCa < 13 mg/dl)?

A

Compromised ability to concentrate urine (dogs)
Increased risk of urolithiasis from calcium oxalate stone formation
GI issues (primarily cats)

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17
Q

What would you expect to see with moderate hypercalcemia (tCa 13-15 mg/dl)?

A

Mild signs
Renal damage (depending on phosphorus)
Possibly triggers pancreatitis (dogs)
Personality change

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18
Q

What would you expect to see with severe hypercalcemia (tCa > 15 mg/dl)?

A

Decreased neuromuscular excitability
Cardiac arrhythmias

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19
Q

What is the most common cause of hypercalcemia in dogs?

A

Hypercalcemia of malignancy / humoral hypercalcemia

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20
Q

What are the most common types of tumors causing hypercalcemia in dogs?

Study These Flashcards
A

Lymphoma
AGASACA

21
Q

What is the common mechanism of tumors causing hypercalcemia?

Study These Flashcards
A

Release of PTH-rp causing increased calcium

22
Q

How would you diagnose hypercalcemia of malignancy?

Study These Flashcards
A

Measurement of PTH-rp
Positive = very strongly supports a tumor, has been positive in dogs with Heterobilharzia
Negative = does not rule out malignancy

23
Q

What is primary hyperparathyroidism usually due to?

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A

A solitary adenoma

24
Q

How would you diagnose primary hyperparathyroidism?

Study These Flashcards
A

Measure serum PTH concentrations
May be above the upper limit of the reference range or may be in the upper end of the range
Interpret in the light of concurrent iCa levels
Inappropriate in the face of hypercalcemia

25
What is treatment for primary hyperparathyroidism?
Surgical removal of the affected gland Ethanol ablation Radiothermal ablation Patient will need calcitriol +/- calcium until other gland wakes up
26
What would you expect to see with hypercalcemia associated with renal disease?
tCa often elevated with renal disease, but iCa is normal CKD results in secondary hyperparathyroidism Some individuals have autonomous parathyroid glands eventually causing PTH to be secreted inappropriately
27
How would you diagnose and treat Vitamin D toxicity?
Measure Vitamin D levels Fluid therapy Glucocorticoids
28
What is idiopathic hypercalcemia linked to?
Acidifying diets
29
How would you diagnose idiopathic hypercalcemia?
Diagnosis of exclusion
30
What would you expect the calcium to be in idiopathic hypercalcemia?
tCa usually <13 mg/dl, usually mild
31
When should you not give glucocorticoids?
If you do not have a diagnosis Will hide lymphoma Will let fungal disease run rampant
32
What should you be careful with when giving Alendronate in cats with idiopathic hypercalcemia?
Substantial risk of esophagitis Must be given on an empty stomach
33
What does low phosphorus suggest?
A PTH type mechanism Tumor is most likely Heterobilharzia Primary hyperparathyroidism
34
What does a normal phosphorus suggest?
Direct osteolysis or low-grade Vitamin D mechanism Osteosarcoma Osteomyelitis Idiopathic hypercalcemia
35
What does a high phosphorus with minimal azotemia suggest?
Vitamin D mechanism Diets Vitamin D toxicity
36
What does a high phosphorus with substantial azotemia suggest?
Harder to figure out Addisons Vitamin D toxicity Renal damage/disease
37
When should you intervene with hypercalcemia?
tCa > 15 mg/dl Calcium is rising fast Ca x Phos > 70 Hypercalcemia and quickly progressive azotemia
38
What should you give first in a hypercalcemic patient?
0.9% NaCl fluids (or NormR)
39
What are the three mechanisms for hypocalcemia?
Inadequate intake of Vitamin D or calcium Inadequate parathyroid Overwhelming acute demand for calcium
40
What are the main clinical signs of hypocalcemia?
Neuromuscular!! Facial rubbing Tremors Hypersensitivity Tetanic seizures Respiratory arrest Behavioral changes
41
How would you diagnose and treat primary hypoparathyroidism?
Measure PTH concentrations - will be subnormal or in the lower end of reference range Treat with Calcitriol long term and calcium short term
42
What types of diets are more prone to cause dietary imbalance of hypocalcemia?
Homemade diet All meat diets are calcium and vitamin D deficient
43
When does puerperal tetany occur?
1-3 weeks post partum
44
What is puerperal tetany due to?
Loss of calcium into milk
45
What type of dogs are most vulnerable for puerperal tetany?
Small breed dog with large litter
46
How would you treat puerperal tetany?
Calcium gluconate IV Avoid noise and excitement
47
How would you manage the emergent hypocalcemic?
Calcium gluconate 0.5-1.5 ml/kg of 10% given IV over 30 mins - need concurrent ECG monitoring 6-10 ml/kg/day as CRI until stabile
48
Why should you use caution with calcium chloride?
Very caustic if extravasated

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