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STEP 2 Cardio + Renal > fluid/acid-base HYPER Ca > Flashcards

fluid/acid-base HYPER Ca Flashcards

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1
Q

Hyper Ca FA. Causes.
3 groups?

ALBUMIN!!!!!!

A

Hyperparathyroidism
Malignancy (breast, squamous cell, multiple myeloma)

menumonic: CHIMPANZEES

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2
Q

Hyper Ca Causes. CHIMPANZEES?

A

Ca supplementation
Hyperparathyroidism
Iatrogenic (thiazides, parenteral nutrition, immobility)
Milk-alkali syndrome (excessive intake of calcium and absorbable alkali)
Paget disease
Adrenal insuf/Acromegaly
Neoplasm
Zollinger-elison (eg. MEN 1)
Excess vitA
Excess vit D
Sarcoidosis or other granulomatous disease

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3
Q

Hyper Ca FA. Symptoms?

A

Asymtomatics
Symptoms - bones, stones, abdominl groans, pshichiatric overstones

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4
Q

Hyper Ca FA. Bones symptoms?

A

Osteopenia, fractures

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5
Q

Hyper Ca FA. Stones symptoms?

A

kidney stones

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6
Q

Hyper Ca FA. abdominal groans symptoms?

A

anorexia, constipation

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7
Q

Hyper Ca FA. prichiatric overtones symptoms?

A

weakness, fatige, irritability, altered mental state

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8
Q

Hyper Ca FA. Best initial test?

A

Check total/ionized calcium and albumin

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9
Q

Hyper Ca FA. reasoning of checkin Ca and albumin?

A

Ca bounded to albumin.
Changes in albumin conc. can lead to Ca conc. alterations, that do not necessarily affect ionized calcium (physiologic active form).

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10
Q

Hyper Ca Uptd.

Bound to plasma proteins (approximately 40 to 45 percent), notably albumin;

partly bound to small anions such as phosphate and citrate (approximately 15 percent);

and partly in the free or ionized state (approximately 40 to 45 percent).

A

.

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11
Q

Hyper Ca what ratio decr. albumin and Ca?

A

0,8 mg/dl fall for every 1g/dl

0,25 mmol/l for 10 g/l

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12
Q

Hyper Ca Corrected: For every gram of albumin above or below 4, the serum calcium is corrected, down or up, respectively, by 0.8 mg/dL.

A

.

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13
Q

Hyper Ca

corrected Ca formula (Payne’s formula)?

A

Corrected Ca (mmol/l) = measured Ca mmol/l + 0,02 x (40 - albumin g/L)

SITOS REIKS pagal vienetus: Corrected Ca (mg/dl) = measured Ca + 0,8 x (4- albumin g/dL)

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14
Q

Hyper Ca
FA. After checking Ca/albumin. what need to consider?

A

Phosphate, Mg, PTH, creatinine, alkaline phosphatase levels.

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15
Q

Hyper Ca
FA.
What tests for further evaluation? malignancy

A

PTHrP (PTH related peptide)

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16
Q

Hyper Ca
FA.
What tests for further evaluation? multiple myeloma

A

serum electrophoresis

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17
Q

Hyper Ca
FA.
What tests for further evaluation? granulomatous disease, iatrogenic vit … intake, TB suspected

A

vit D levels

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18
Q

Hyper Ca.
Other workups?

A

ECG may show shortened QT interval

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19
Q

Moderate hyper Ca total range?

A

3-3,5

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20
Q

Mild hyper Ca total range?

A

above 3 mmol/.

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21
Q

severe hyper Ca total range?

A

> 3,5

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22
Q

normal ionized?

A

1.2 to 1.4 mmol/L

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23
Q

Mild hyper Ca ionized range?

A

1.4 to 2 mmol/L

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24
Q

moderate hyper Ca ionized range?

A

2 to 2.5 mmol/L

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25
severe hyper Ca ionized range?
2.5 to 3 mmol/L
26
Hyper Ca pagal etiologijos nustatyma, koks pirmas istyrimas?
PTH. Tada nustatom ar cia su relatad or non related to parathyroid If elevated - cause parathyroid
27
Hyper Ca uptd. parathyroid mediated? causes
Primary hyperparathyroidism (sporadic) Inherited variants: MEN, Familial isolated hyperparathyroidism, Hyperparathyroidism-jaw tumor syndrome Familial hypocalciuric hypercalcemia Tertiary hyperparathyroidism (kidney failure)
28
Hyper Ca uptd. non - parathyroid mediated? causes
Hypercalcemia of malignancy Vit D intox Granulomatous diseases Drugs: Thiazide diuretics, Lithium, vit A excess other: Hyperthyroidism, Acromegaly, Pheochromocytoma, Adrenal insufficiency, Immobilization, Parenteral nutrition, Milk-alkali syndrome
29
Hyper Ca FA diagnostic algo. 1st 2 steps?
Hypercalcemia (corrected Ca) then PTH concentration
30
Hyper Ca FA diagnostic algo. If PTH high-normal?
its PTH dependent hypercalcemia
31
Hyper Ca FA diagnostic algo. If PTH dependent hypercalcemia?
Check urine Ca
32
Hyper Ca FA diagnostic algo. PTH dependent hypercalcemia. What if urine Ca low or high?
Low - familial hypercalcemic hypocalciuria High - 1 and 3 hyperparathyroidism
33
Hyper Ca FA diagnostic algo. If PTH low?
Its PTH independent hypercalcemia
34
Hyper Ca FA diagnostic algo. PTH independent hypercalcemia. What to check then?
Vit D (25 OH and 1,25) PTH related protein
35
Hyper Ca FA diagnostic algo. PTH independent hypercalcemia. High 25OH?
Vit D intox
36
Hyper Ca FA diagnostic algo. PTH independent hypercalcemia. High 1, 25 OH?
sarcoidosis, lymphoma
37
Hyper Ca FA diagnostic algo. PTH independent hypercalcemia. Inc. PTHrP?
Breast cancer, squamous cell, ovarian, renal cancers
38
Hyper Ca FA diagnostic algo. PTH independent hypercalcemia. normal vit D and PTHrP?
Multiple myeloma, immobilization, hyperthyroidism, vit A tox, acromegaly, milk-alkali syndrome
39
Fa Hyper Ca treatment. 1 st thing?
treat underlying cause
40
Fa Hyper Ca treatment. If mild hyperCa (corected calcium < 12 mg/dL)?
does not require urgent treatment. Maintain hydration (to prevent stones) + avoid factors that can worsen hyper Ca (thiazides, high Ca intake, inactivity)
41
Fa Hyper Ca treatment. If severe hyper Ca > 14 mg/dL?
Need urgent treatment. Isotonic fluids (+/- furosemide) and calcitonin Consider bisphosphonates (zoledronic acid, pamidronate)
42
Fa Hyper Ca treatment. If severe hyper Ca > 14 mg/dL. Intake of sodium what effect?
High intake of Na (in isotonic) facilitates renal calcium excretion and prevents renal complications (stones)
43
Fa Hyper Ca treatment. If 12-14 mg/dl, but asymptomatic?
not needed emeregency treatment. They may follow same precautions as for mild + therapies eg isotonic fluids ------> to facilitate Ca excertion
44
Fa. HYPO Ca. range
< 8,5 mg/dl
45
Fa. HYPO Ca. etiologies? 3 groups
Parathyroid related Malnutrition/vit D deficiecy Other: hypoMg, pancreatitis, chelation from blood products
46
Fa. HYPO Ca. Parathyroid related causes?
Hypoparathyroidism (idiopathic, postsurgical), CKD (causing secondary hyperparathyroidism, pseudohypoparathyroidisim (PTH resistance)
47
Fa. HYPO Ca. Parathyroid related cause in infants?
Di George syndrome
48
Fa. HYPO Ca. Symptoms?
Abdominal and muscle cramps, dyspnea, tetany, perioral and acral paresthesias, convulsions
49
mneumonic: Loop diuretics = Loose Calcium Thiazide - inc. Tubular reabs. of Ca
.
50
clasical patient of hypoCa?
hypoCa in patient with tetany and cramps following thyroidectomy - because of parathyroidectomy as a complication
51
classical presentation on Hypo Mg in what patients?
alcoholics
52
Fa. HYPO Ca. Typical facial symptom?
Facial spasms elicited from tappin on facial nerve (Chvistek sign)
53
Fa. HYPO Ca. Typical hand symptom?
carpal spasm after arterial occlusion by BP cuff (Trousseau sign)
54
Fa. HYPO Ca. most accurate tests?
Ionized Ca and PTH.
55
Fa. HYPO Ca. after ionized Ca and PTH. What other tests?
Mg (low level can induce PTH resistance) Albumin 25OH and 1,25 OH vit D electrolyte BUN, creatinine, alkaline phosphatase may also be useful depending on clinical situation
56
Fa. HYPO Ca. other than lab workup?
ECG - prolonged QT interval
57
Fa. HYPO Ca. treatment. first?
underlying cause
58
Fa. HYPO Ca. treatment. route?
p/os - in most cases I/v in more severe
59
Fa. HYPO Ca. treatment. what apart Ca?
ensure Mg repletion
60
uptd. what is severe/acute hypo Ca?
● Symptoms (eg, carpopedal spasm, laryngospasm, bronchospasm, seizures, decreased cardiac function) ● A prolonged QT interval OR ●In asymptomatic patients with an acute decrease in serum corrected calcium to ≤7.5 mg/dL (≤1.9 mmol/L), who may develop serious complications if untreated
61
uptd. hypo Ca. in CDK but asymtomatic/mild symptoms, what treat?
correction of hyperphosphatemia and of low circulating 1,25-dihydroxyvitamin D are usually the primary goals. intial therapy with Ca is not waranted
62
uptd. initial treatment for severe hypoCa?
Initially, IV calcium (1 or 2 g of calcium gluconate, equivalent to 90 or 180 mg elemental calcium, in 50 mL of D5W or NS) can be infused over 10 to 20 minutes. may repeat after 10-60 min is symptoms persist. then infusion: Patients typically require 0.5 to 1.5 mg/kg of elemental calcium per hour. durnas skiedimas nurodytas, tipo 1litra saline arba D5W ideti 11g Cagluc ir uzstatyti and 50 ml/h
63
10 proc 10 ml = 1000mg (100 mg /ml) Elemental calcium 9,3 mg/ml
.
64
uptd. HypoCa. Concurent hypoMg. what treatment?
2 g (16 mEq) of magnesium sulfate should be infused as a 10% solution over 10 to 20 minutes, followed by 1 gram (8 mEq) in 100 mL of fluid per hour
65
Fa. hypoMg. range?
< 1,5 mEq/l
66
Fa. hypoMg. etiologies? 3
decr. intake incr. loss miscelaneous
67
Fa. hypoMg. decr. intake causes?
malnutrition, malabsorbtion, short bowel syndrome, total parenteral nutrition, PPI drugs
68
Fa. hypoMg. inc. loss causes?
diuretics, diarrhea, vomiting, hyperCa, excessive alcohol use
69
Fa. hypoMg. miscelaneous causes?
DKA, pancreatitis, ECF expansion
70
Fa. hypoMg. Symptoms?
hyperactive reflexes, tetany, paresthesias, irritability, confusion, lethargy, seizures, arrhythmias.
71
Fa. hypoMg. diagnosis? 2 steps
labs: shows concurent hypoCa and hypoK ECG - prolonged PR and QT
72
Fa. hypoMg. treatment?
i/v or oral supplementation=
73
Fa. what is must to correct hypo Ca and Hypo K.
Magnesium. HypoK and hypoCa will not correct without magnesium correction

STEP 2 Cardio + Renal (55 decks)

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