PHRM 825 > PHRM 825: Fluids and Electrolytes - Electrolytes - Ca+2 > Flashcards

PHRM 825: Fluids and Electrolytes - Electrolytes - Ca+2 Flashcards

(48 cards)

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1
Q

Normal Ca+2 blood levels

A

8.5-10.5 mg/dL

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2
Q

Calcium is necessary for ____ formation and _____ funciton

A

bone and neuromuscular

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3
Q

Calcium serum concentrations are controlled mainly by what 3 things?

A

parathyroid hormone, vitamin D, and calcitonin

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4
Q

Organs involved in calcium metabolism include

A

bone, kidneys, and the intestine

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5
Q

Causes of hypocalcemia (7)

A
  • Magnesium deficiency
  • Large volumes of blood products
  • Hypoalbuminemia
  • Post-op hypoparathyroid
  • Vitamin D deficiency
  • Thyroid surgery
  • Medications
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6
Q

Hypocalcemia is typically seen in what kinds of patients?

A

Hospital patients

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7
Q

Corrected calcium equation

A

Corrected Ca+2 = measured Ca+2 + [(4 - measured albumin) x 0.8]

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8
Q

When available, you should use the _____ over the corrected calcium calculation

A

ionized calcium level

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9
Q

Normal ionized calcium levels

A

4.6-5.1 mg/dL (milligram, NOT milliequivalents)

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10
Q

What does ionized calcium levels represent?

A

The amount of calcium available for use in the body

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11
Q

Clinical presentation of hypocalcemia in the neuromuscular system

A
  • Parasthesias
  • Muscle cramps
  • Tetany
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12
Q

Clinical presentation of hypocalcemia in the CNS

A
  • Depression
  • anxiety
  • Memory loss
  • Confusion
  • Hallucination
  • Seizures
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13
Q

Clinical presentation of hypocalcemia in the dermatologic system

A
  • Hair loss
  • Grooved brittle nails
  • Eczema
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14
Q

Clinical presentation of hypocalcemia in the cardiac system

A 
-Prolonged QT
Decreased myocardial contractility
-Arrhythmias
-Bradycardia
-Hypotension
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15
Q

Acute treatment of hypocalcemia

A
  • 100-300 mg of elemental Ca+2 IV oer 5-10 minutes
  • Usual administration rate for Ca+2 is 1 gm/hr
  • Correct hypomagnesemia
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16
Q

What should you NEVER give a patient when giving calcium to treat hypocalcemia?

A

Bicarb or phos solutions (It will precipitate and create chalk in the bloodstream)

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17
Q

1 g CaCl = ____ g Ca gluconate

A

3

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18
Q

1 g CaCl= ____ mg elemental calcium

A

270

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19
Q

3 g Ca gluconate = ____ mg elemental calcium

A

270

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20
Q

Calcium chloride can be administered PIV when?

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A

During a code (cardiac arrest)

21
Q

Calcium gluconate is preferred for ____

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A

PIV administration

22
Q

What aspects of calcium gluconate make it preferred for PIV administration

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A
  • Lower percentage of elemental Ca+2
  • Less predictable increase in Ca+2 concentration
  • Less risk for extravasation
23
Q

Chronic treatment of hypocalcemia

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A
  • PO calcium

- Vitamin D supplementation

24
Q

PO calcium treatment for hypocalcemia

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A

-1-3 g/day of elemental Ca+2

25
1 g elemental Ca+/day is equivalent to _____ of CaCO3
650 mg PO QID
26
Vitamin D supplementation for hypocalcemia
- Calcitriol 0.25 mcg PO daily or every other day | - May need to increase by 0.25 mcg q 4-8 weeks to 1 mcg PO daily
27
Hypercalcemia is typically present in what 2 disease states?
Cancer and hyperparathyroidism
28
3 mechanisms that lead to hypercalcemia
- Increased bone resorption - Increased gastrointestinal absorption - Decreased elimination by the kidneys
29
Hypercalcemia is often ____ especially when serum calcium is ____
asymptomatic; <13 mg/dL
30
Clinical presentation of acute onset of hypercalcemia
- Anorexia - Nausea - Vomiting - Constipation - Polyuria - Polydipsia - Nocturia
31
Clinical presentation of hypercalcemic crisis
- ARF - Obtundation - Coma - Life-threateing arrhythmias
32
Hypercalcemic crisis is characterized by calcium concentration of ___
>15 mg/dL
33
Clinical presentation of chronic hypercalcemia
- Metastatic calcification - Nephrolithiasis - CRF
34
Goals of treatment for hypercalcemia
- Reverse signs and symptoms - Restore to normal calcium concentrations - Identify and treat the underlying cause(s) - Prevent long term consequences, renal insufficiency
35
Treatments for hypercalcemia
- Volume expansion/loop diuretics - Calcitonin - Bisphosphonates - Glucocorticoids
36
Volume expansion/Loop diuretics should be used to treat hypercalcemia when renal function is ____
normal to moderately impaired
37
Volume expansion/loop diuretics should be used in ____ patients that have ____
symptomatic patients; hypercalcemia
38
In hypercalcemia, symptomatic patients are often _____ because of ___
dehydrated; vomiting/ polyuria
39
When administering NS to treat _____, you should monitor ____
hypercalcemia; ins and outs or CVP
40
How does furosemide help treat hypercalcemia
- Increases Ca+ urinary excretion | - Minimizes volume overload
41
Calcitonin should be used to treat _____ in patients with _____
hypercalcemia; moderate to severe renal dysfunction or CHF
42
Calcitonin _____ serum Ca+2 by ____
reduces; inhibiting bone resorption and reducing renal tubular reabsorption
43
How do bisphosphonates help treat hypercalcemia
Prevent bone reabsorption
44
_____ bisphosphonate is more effective at reducing Ca+2 levels than ____ bisphosphonate
Pamidronate; etidronate
45
Bisphosphonates cause Ca+2 concentrations to decline in ____ days
~2
46
Glucocorticoids can be used to treat hypercalcemia in patients caused by
- Multiple myeloma - Leukemia - Lymphoma - Sarcidosis
47
How do glucocorticoids treat hypercalcemia
- Decrease GI absorption | - Interfere with vitamin D metabolism (increases bone resorption and decreased osteoblast proliferation)
48
Glucocorticoids have a ____ onset and increase the risk of ____ or _____
Onset; hyperglycemia or infection
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