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503 (Renal) > Hypercalcemia and Hypophosphatemia > Flashcards

Hypercalcemia and Hypophosphatemia Flashcards

1
Q

What is normal serum calcium

A

8.5-10.5 mg/dl

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2
Q

What is normal ionized serum calcium

A

4.4-5.4 mg/dl

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3
Q

What protein has to be accounted for when referring to to total Calcium, does this protein cause any change in ionized Calcium

A

Albumin,no

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4
Q

What is the equation for corrected Calcium

A

(total measured serum calcium) + 0.8(4- measured serum albumin)

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5
Q

What is the normal serum albumin level

A

4 mg/dl

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6
Q

How does PTH affect bones,kidneys, and the gut

A

stimulates osteoclasts and cause bone breakdwon, increases reaborption of calcium in distal renal tubules, indirectly increases intestinal calcium absoption

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7
Q

What causes calcitonin to be increased

A

When ionzied calcium concentrations are high

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8
Q

What are ways hypercalcemia can occur

A

accelerated bone resporption, Excessive GI absorption, decreaed renal excretion of calcium

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9
Q

What are the ranges for hypercalcemia with respect to total serum calcium, ionized calcium

A

greater than 10.5, greater than 5.4

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10
Q

What is the disease that accounts for 90% of cases of hypercalcemia

A

primary and secondary hyperparathyroidism, malignancy

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11
Q

What is the cause of primary hyperparthyroidsim, secondary, tertiary

A

parathyroid adenoma, hyperplasia of the glands (adaptive disease in the setting of CKD), advanced renal failure

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12
Q

How high can calcium get due to malignancy

A

over 13 mg/dl

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13
Q

What are drugs that cause hypercalcemia

A

ergocalciferol, calcitrol, cholecalciferol, litihium, vitamin A, thiazide diuretics

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14
Q

How do thiazide diuretics cause hypercalcemia

A

increase renal tubular reabsorption of calcium in distal tubule, block Na reabsorption and increase calcium reabsorption, lowers urinary calcium excretion

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15
Q

What are moderate hypercalcemia total serum calcium levels, severe

A

12-14 mg/dl, greater than 14 mg/dl

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16
Q

What are symptoms of severe hypercalcemia

A

profound dehydration, renal failure, cardiovascular/neuromuscluar dysfunction, coma

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17
Q

What is the fluid that is used to treat severe hypercalcemia, why

A

09.% normal saline with loop diuretics to help increase calcium excretion, corrects volume depletion/increases renal excretion of calcium

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18
Q

Which treatment will cause rapid decrease in serum calcium

A

calcitonin

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19
Q

What treatment provides sustained effect in lowering calcium

A

Bisphosphonates

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20
Q

What is the last restort for hypercalcemia

A

Dialysis

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21
Q

What is the dose of normal saline in hypercalcemia

A

200-300 ml/hr, could be lower with older patients

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22
Q

What is the mechanism for calcitonin

A

Functionally antagonizes the PTH

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23
Q

What is the does for calcitonin, how can it be administered

A

4 IU/kg, IM/SC

24
Q

T/F: The efficacy of calcitonin is limited to the first 72 hours and if responsive can repeat every 4-6 hours

A

False: The efficacy is limited to the 1st 48 hours and if responsive can be repeated every 6-12 hours from dose

25
Q

T/F: The nasal formulation of Calcitonin does not work

A

True

26
Q

What is the duration of bisphosphonates, when does the max effect take place

A

2-4 weeks, 2-4 days

27
Q

What type of bisphosphonate is most commonly used in hypercalcemia, what is the dose

A

Zolendronic Acid, 4 mg IV over 15 minutes

28
Q

When should bisphosphonates be avoided in a patient

A

if CrCl is less than 30ml/min

29
Q

How often will bisphosphonates be administered in malignancy, what drug is administered as well and why

A

every 3 to 4 weeks, denosumab for refactory hypercalcemia

30
Q

What is the role of glucocorticoids, what is one way they work

A

hypercalcemic presentation due to drugs or disease, decrease intestinal calcium

31
Q

What drug can be used for chronic hypercalmia in hyperparathyroidism

A

sensipar (cinacalcet) and Parsabiv (etelcalcetide)

32
Q

What is the starting dose for sensipar

A

30 mg daily with food

33
Q

What is the dosing for parsabiv

A

5 mg IV bolus 3 times per week at the end of hemodialysis

34
Q

T/F: When calcium is greater than or equal to 15 parental therapy is required

A

True

35
Q

What creatine clearence is bad for bisphosphanates

A

30

36
Q

What is a normal phosphorous range

A

2.5-4.5 mg/dl

37
Q

What is the organ that affects phosphours levels the most

A

kidney

38
Q

What inhibits phosphorous reabsorbtion

A

PTH and calcitrol

39
Q

What are moderate and severe ranges of hypophosphatemia

A

1.5 mg/dl, less than or equal to 1 mg/dl

40
Q

What the four key ways hypophosphatemia can occur

A

Redistribution of phosphate from extracellular fluid into cells, decreased intestinal absoprtion of phosphate, removal by renal replacement therapies

41
Q

Where is phosphorous absorbed

A

From the intestines

42
Q

What are the symptoms due to consequences of intracellular phosphorous depletion

A

Reduce oxygen tissue release, ATP levels fall and cell functions begin to fail

43
Q

How low does phosphate usually get to cause symptoms

A

less than 1.0

44
Q

Which oral phosphorous has the least amount of potassium

A

K phos neutral

45
Q

T/F: A patient will receive IV phos therapy whether they are symptamatic or not

A

True

46
Q

When should IV phos be switched to PO therapy

A

Once over 1.5

47
Q

What is the IV dose for symptomatic patients with phosphorous greater than 1.5, less than 1.5

A

Max 30 mmol over 6 hours, max 80 mmol over 8-12 hours

48
Q

When should phosphorous doses be lower, held off

A

Ca is around 10.5 to 12 cut the dose in half, renal dysfunction, if the Ca is more than 12 correct the calcium first due to a risk of calcification

49
Q

When should potassium phosphate be given IV over sodium phosphate

A

When the patient’s potassium is less than 3.5 mEq/L

50
Q

T/F: When PTH is present this stimulates the synethesis of calcitriol

A

True

51
Q

What drug should be used to lower calcium quickly if the patient is symptomatic

A

Calcitonin

52
Q

What drug should be used if the patient has longer term hypercalcemia due to malignancy, excessive bone resorption

A

Bisphosphonates

53
Q

What is the mechanism of action for sensipar (cinclacet)

A

Decrease PTH by increasing sensitivity of calcium receptor on parathyroid gland

54
Q

What is the biggest culprit for hypophosphatemia

A

continuous renal replacement therapies, dialysis

55
Q

T/F: If the calcium is greater than 12 mg/dl half the dose of phosphorous

A

False: If calcium is greater than 12 mg/dl hold on phosphorous because calcification can occur, Half the does if the calcium is between 10.5 to 12

56
Q

T/F: Monitor phosphorous every 6 hours

A

True

503 (Renal) (6 decks)

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