Mineral Balance Lectures

Question 1

Calcium Reference Range

Answer 1

8.6-10.0 mg/dl

Question 2

Calcium Functions

Answer 2

• Skeletal mineralization
• Nerve impulse transmission
• muscle contraction
• blood coagulation
• enzyme cofactor
• cell membrane integrity and permeability

Question 3

Organs associated with Calcium balance

Answer 3

• Small intestine
• Bones
• Kidneys

Question 4

Hydroxyapatite

components

Answer 4

Calcium+Phosphorus+hydroxide

Question 5

Hydroxyapatite importance

Answer 5

99% of calcium in bones and teeth is in this form

Question 6

Calcium bound to proteins (%)

Answer 6

-40%

most bound to albumin

Question 7

Free “ionized” calcium and pH (acidosis/alkalosis)

Answer 7

Acidosis: more free Ca2+ (less binding)
Alkalosis: less free Ca2+ (more binding)

Question 8

Free calcium (%)

Answer 8

50%

Question 9

Calcium in salts (%)

Answer 9

10%

Question 10

Ionized Calcium function

Answer 10

• Physiologically active calcium

- monitored in heart surgery

Question 11

Ionized calcium reference range

Answer 11

4.6-5.3 mg/dl

Question 12

PTH and calcium

Answer 12

• Secretion increases calcium levels

- glands have calcium receptors that respond to Ca levels

Question 13

How PTH increases calcium

Answer 13

• Bone resorption and release of Ca to blood.
• Increase renal reabsorption of Ca (excretion of phosphorous)
• Intestinal reabsorption

Question 14

Calcium and Phosphorous relationship

Answer 14

• Inverse relationship
• Reabsorption of Ca = secretion of Phosphorous
• Influenced by PTH

Question 15

Vitamin D/Calcium

Answer 15

Increases calcium and phosphate by increasing absorption from GI tract

Question 16

Vitamin D/Calcium

Answer 16

Increases calcium and phosphate by increasing absorption from GI tract

Question 17

Vitamin D/PTH

Answer 17

Increases bone resorption and enhances PTH

Question 18

Calcitonin

Answer 18

Inhibits bone resorption, promotes bone formation

Question 19

primary Hyperparathyroidism

Answer 19

Increased calcium, PTH

Decreased phosphorous

Question 20

Hypoparathyroidism

Answer 20

Decreased PTH
Decreased calcium
Increased phosphorous
(injury)

Question 21

Hypercalcemia conditions

Answer 21

.Hyperparathyroidism
.Malignancy
.Renal failure
.Multiple myeloma
.Increased Vit. D
.Milk Alkali syndrome
.Diuretics, Lithium, Vit. A

Question 22

Hypercalcemia Symptoms

Answer 22

Kidney stones
Fractures
Hypertension
Arrhythmia
Constipation
Disorientation

Question 23

Hypocalcemia

Answer 23

Hypoalbuminemima
Hypoparathyroidism
Renal failure
Decreased magesium
Citrate toxicity

Question 24

Hypocalcemia/Hypoalbuminemia

Answer 24

Liver disease
nephrotic syndrome
malnutrition

Question 25

Hypocalcemia symptoms

Answer 25

``` Neuromuscular irritability Tetany Trosseau and Chvostek's Depression Cardiac irregularity ```

Question 26

Total Calcium Specimen

Answer 26

``` Serum Li heparin plasma No EDTA Hemolysis (decrease) HCI urine ```

Question 27

Ionized calcium requirements

Answer 27

Anaerobic Heparin whole blood Serum/plasma ph and Ca2+ reported

Question 28

Rickets

Answer 28

Vitamin D deficient Bone deformity Abnormal mineralization Children

Question 29

Osteomalacia

Answer 29

Adults Vitamin D deficient Abnormal mineralization

Question 30

Osteoporosis

Answer 30

Low bone mass | Assess bone density and PTH/Vitamin D

Question 31

Paget's disease

Answer 31

Excessive bone resorption Increased ALP Treat w Calcitonin

Question 32

Phosphorous reference range

Answer 32

2.5-4.5 mg/dl

Question 33

Phosphorous distribution

Answer 33

80% bone 20% soft tissue <1% in bloodstream

Question 34

Phosphorous regulation

Answer 34

``` Kidneys PTH (decrease) Vitamin D (increase) GH Calcitonin ```

Question 35

Hyperphosphatemia

Answer 35

Decreased excretion Cellular shift (acidosis) PTH (low)

Question 36

Hypophosphatemia conditions

Answer 36

``` Increased excretion Diuretics DKA increased PTH Cell shift (alkalosis) Malabsorption ```

Question 37

hypophosphatemia symptoms

Answer 37

``` Weakness double vision slurred speech dizziness respiratory failure impairment of cardiac contractility ```

Question 38

Phosphorous specimen

Answer 38

serum Li hep plasma Hemolysis (increase) Diurnal variation

Question 39

Magnesium ref range

Answer 39

1.6-2.6 mg/dl

Question 40

Magnesium distribution

Answer 40

50% bone 40% muscle 1% RBC

Question 41

Magnesium forms

Answer 41

Ionized: 55% Protein bound: 30% Ionic: 15%

Question 42

Hypomagenesiemia symptoms

Answer 42

``` Hypertension Arrhythmia Weakness tetany Depression psychosis ```

Question 43

Hypermagnesemia symptoms

Answer 43

``` Hypotension Bradycardia warm skin nausea vomiting hypocalcemia ```

Question 44

Magnesium specimen

Answer 44

Serum Heparin plasma 24 h urine (HCl)

Question 45

Magnesium specimen

Answer 45

Serum Heparin plasma 24 h urine (HCl)

Question 46

Metabolically active Vitamin D

Answer 46

1,25 dihydroxy vitamin D3

Question 47

Secondary hyperparathyroidism

Answer 47

Increased PTH Increased phosphorous Decreased calcium