Hypercalcemia and Hypocalcemia

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Where is most of the calcium stored in the body?

bones

What is the primary control of intestinal calcium absorption?

Vitamin D

What effect do glucocorticoids have on absorption of calcium?

decrease

Renally, calcium is reabsorbed via co-transport in the ascending limb with what ion?

Chlorine

PTH increases reabsorption of calcium in what part of the nephron?

distal convoluted tubule

Vitamin D is transformed into it's active form in what organ?

kidneys

Would a dog with osteopenia neccesarily have a low serum calcium?

no

Is the calcium in the bones quickly mobilized?

no

What are the three forms that serum calcium can take?

Ionized Calcium
Protein Bound Calcium
Complexed Calcium

What are three compounds that calcium complexes with?

phosphate
citrate
bicarbonate

What form of serum calcium is active?

ionized

Would a dog with low total calcium always have clinical signs of hypocalcemia?

no

How will an increase in pH shift the form of serum calcium?

towards bound

How will an alkaline pH change shift the form of serum calcium?

towards bound

How will a decrease in pH shift the form of serum calcium?

towards ionized

How will an acid pH change shift the form of serum calcium?

towards ionized

How does Hypoalbuminemia affect ionized calcium?

no effect

How does Hypoalbunimia affect total calcium?

reduces

What is the formula to determine calcium levels in the presence of abnormal albumin levels?

Adjusted Ca = Calcium - Albumin + 3.5

How does the normal serum levels of young animals compare with adults?

younger animals have higher normal serum calcium

What are three types of hyperparathyroidism?

Primary hyperparathyroidism
Renal Secondary Hyperparathyroidism
Nutritional Secondary Hyperparathyroidism

Hypercalcemia has what effect at the collecting ducts?

interferes with ADH

Hypercalcemia has what effect at the renal tubules?

nephrocalcinosis

Hypercalcemia has what effect at the glomerulus?

afferent limb vasoconstriction

When I say hypercalcemia, you say...

Lymphosarcoma

What is a less likely neoplasia that may cause hypercalcemia?

Squamous Cell Carcinoma

What are the two main mechanisms for hypercalcemia by malignancy?

bone lysis (via tumor produced cytokines)
PTH-rP production

What are the differential diagnosis for hypercalcmia? (7)

Malignancy
Renal Failure
Primary Hyperparathyroidism
Hypoadrenocorticism
Diffuse bone disease
Granulomatous Disease
Hypervitaminosis D

Is Hypercalcemia secondary to renal failure more common in dogs or cats?

cats

What are the three mechanisms of hypercalcemia secondary to renal failure?

Decreased renal calcium excretion
Increased responsiveness to Vitamin D
Autonomous parathyroid gland secretion

What are the causes of Primary Hyperparathyroidism?

Parathyroid adenoma
Parathyroid adenocarcinoma
Familial hyperparathyroidism

What is the most common cause of primary hyperparathyroidism?

parathyroid adenoma

How do you diagnose primary hyperparathyroidism?

Hypercalcemia/hypophosphatemia
High or normal PTH with hypercalcemia
Ultrasound of the neck
Cervical exploration

What are three causes of Hypervitaminosis D?

Excessive supplementation
Vitamin D containing plants
Vitamin D3 rodenticides

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