Endocrinology: Calcium + Parathyroid

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UNITS

When running an ionized calcium, what should you pay attention to (varies between labs)

decreases

Alkalosis __________ ionized calcium (how does it effect?)

Increases

Acidosis __________ ionized calcium (how does it effect?)

50%

What percent of total calcium is ionized (biologically active)?

NO (measure ionized calcium when possible)

If total calcium is low, should you try to correct it? if so, how?

hypercalcemia

Calcitonin is released in response to ___________

PTH

What is the number one hormone that is mainly responsible for calcium regulation?

hypocalcemia

What stimulates conversion of Vitamin D to active form?

Increase Calcium intestinal absorption

What is the main function of vitamin D?

shuts down PTH secretion

How does the parathyroid gland respond to hypercalcemia?

Intestines
Kidney
Bone

Where are three sites that calcium is regulated (absorbed or excreted)

directly, inverse (reciprocal)

Phosphorus itself does not _________ effect PTH levels, however Phosphorus and calcium have a _________ relationship

decrease

An increase in blood phosphorus will ________ blood calcium

PU/PD

Main clinical sign of hypercalcemia is...

double check (ionized calcium)

What should you do first if you identify hypercalcemia on bloodwork?

lymph node aspirate
Bone marrow evaluation

What are two evalutations/tests you should perform to help rule out etiologies for hypercalcemia?

Parathyroid adenoma

What is the number one cause of hyperparathyroidism?

hypercalcemia

Clinical signs of hyperparathyroidism are mainly due to (and the same as) ___________________

False

T/F: in cases of hyperparathyroidism, a mass is usually palpable

inappropriate

elevated PTH in the face of hypercalcemia is _____________

70

If Ca x P levels are > __ be worried about soft tissue calcification!

IV fluids
Diuretic therapy
Glucocorticoid therapy

What are 3 pillars of hypercalcemia therapy?

fluid deficits have been replaced

Diuretic therapy (furosemide) should only be initiated if ________________.

Diagnosis has been made

Glucocorticoid therapy (prednisone) should only be initiated if ______________.

2-3

Fluid therapy for hypercalcemia is saline diuresis at ___________ times maintenance

Surgical removal

#1 recommended Therapy for hyperparathyroidism?

Calcium

you should always monitor ___ levels post surgery for hypercalcemia!

14, Vitamin D, 18

If pre-surgical calcium is greater than __ mg/dl, begin therapy with _________ before surgery (if greater than ____, begin 2-3 days prior)

Lymphoma, Anal sac adenocarcinoma

In the dogs, hypercalcemia of malignancy is most commonly associated with what two neoplastic conditions?

Lymphoma, squamous cell carcinoma

In the cat, hypercalcemia of malignancy is most commonly associated with what two neoplastic conditions?

Tumors (PTH related protein)

Where does PTHrp come from?

intermittent

With PTHrp, hypercalcemia may be...

Malignancy

The most common cause for pathologic hypercalcemia is...

Malignancy, Primary hyperparathyroidism, Vitamin D toxicity

Three causes of most severe hypercalcemia

Seizure/tetany

#1 sign of hypocalcemia

Hypocalcemia

Facial pruritis is most often caused by

hypoparathyroidism

Most dogs present with acute signs of hypocalcemia when _____________ is the cause

Hypoparathyroidism

What should you suspect in an animal with profound hypocalcemia, hypomagnesemia, hyperphosphatemia, norma renal parameters and Low to undetectable PTH levels.

Clinical signs

The goal of therapy for hypocalcemia is to treat the ____________

animal

For hypocalcemia, one should treat the ___________, not the blood work

NO (reactions occur)

Can you give subcutaneous calcium as long-term hypocalcemia treatment?

Oral supplements

Best long-term treatment for hypoparathyroidism/hypocalcemia

flacid

Ecclampsia may lead to _______ paralysis in cats

FALSE

T/F: Phosphate enemas can be given to dehydrated cats

PTH

____ is considered a major uremic toxin

hyperparathyroidism

Decreased GFR results in Increased P, resulting in decreased Ca++, resulting in increased PTH, (renal secondary __________)

Increased PTH in azotemic animal

How do you diagnose renal secondary hyperparathyroidism?

Decreased total calcium (40% is protein bound)

If you have an animal with low albumin, what secondary effect can you have?

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