Electrolyte Disorders (CA)

Question 1

When analyzing Ca levels what else should you look at

Answer 1

Albumin

Question 2

What is half of calcium bounded to

Answer 2

1. Albumin
   * the unbound “ionized” fraction is active

Question 3

What is the level of hypocalcemia

Answer 3

<8.2 mg/dL

Question 4

What is the etiology of hypocalcemia

Answer 4

1. Hypothyroidism
2. Hypoparathroidism
3. Pancreatitis
4. Renal insufficiency
5. Crush injuries
6. Necrotizing infections

Question 5

What is responsible for the immediate regulation of Ca levels

Answer 5

Parathyroid hormone

Question 6

Why are critical ill patients usually Hypocalcemic

Answer 6

1. Bc of decreased albumin that often occurs
   *ionized Ca may be normal

Question 7

What are the signs and symptoms of hypocalcemia

Answer 7

1. Hypertension
2. Peripheral and perioral paraesthesia
3. Abdominal pain and cramps
4. Lethargy
5. Irritability in infants

Question 8

What are the common diagnostic signs of hypocalcemia

Answer 8

1. Trousseau sign
   *involuntary contraction of the uncles in the hand and wrist that occurs after the compression of the upper arm. With blood pressure cuff
2. Chvostek sign
   *irritability of the facial nerve in response to tapping over the facial nerve

Question 9

What are the EKG changes for Hypocalcemia

Answer 9

1. Prolonged QT interval on EKG

Question 10

What is the treatment for hypocalcemia (acute symptomatic)

Answer 10

1. 100-200mg of elemental Ca IV over 10 min
   *10% Ca cluconate contains 93mg of elemental Ca
   *10% Ca chloride contains 272 mg of elemental Ca

Question 11

What is the treatment of Hypocalcemia (chronic)

Answer 11

1. For renal insufficiency use vitamin D along with oral a supplements and phosphate-binding antacids

Question 12

What is the level for hypercalacemia

Answer 12

> 10.2mg/dl

Question 13

What are the causes of Hypercalcemia

Answer 13

1. Parathyroid related
   *hyperparathyroidism
2. Malignancy-related
   *solid tumors with metastasis
   *paraneopalstic syndromes
3. Vitamin D related
4. Renal failure

Question 14

What are the signs and symptoms of Hypercalcemia

Answer 14

1. Stones (renal colic)
2. Bones (osteitis fibrosa)
3. Moans (constipation)
4. Groans (neuropsych symptoms)

Question 15

What changes will occur on the EKG (Hypercalcemia)

Answer 15

1. Short QT interval

Question 16

What is the treatment for Hypercalcemia

Answer 16

1. Saline diuresis
2. Furosemide 20-80mg
   *will inhibit Ca reabsorption in the nephron