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Endocrinology: Calcium + Parathyroid
When running an ionized calcium, what should you pay attention to (varies between labs)
Alkalosis __________ ionized calcium (how does it effect?)
Acidosis __________ ionized calcium (how does it effect?)
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?
Calcitonin is released in response to ___________
What is the number one hormone that is mainly responsible for calcium regulation?
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?
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
An increase in blood phosphorus will ________ blood calcium
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?
What is the number one cause of hyperparathyroidism?
Clinical signs of hyperparathyroidism are mainly due to (and the same as) ___________________
T/F: in cases of hyperparathyroidism, a mass is usually palpable
elevated PTH in the face of hypercalcemia is _____________
If Ca x P levels are > __ be worried about soft tissue calcification!
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 ______________.
Fluid therapy for hypercalcemia is saline diuresis at ___________ times maintenance
#1 recommended Therapy for hyperparathyroidism?
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?
With PTHrp, hypercalcemia may be...
The most common cause for pathologic hypercalcemia is...
Malignancy, Primary hyperparathyroidism, Vitamin D toxicity
Three causes of most severe hypercalcemia
#1 sign of hypocalcemia
Facial pruritis is most often caused by
Most dogs present with acute signs of hypocalcemia when _____________ is the cause
What should you suspect in an animal with profound hypocalcemia, hypomagnesemia, hyperphosphatemia, norma renal parameters and Low to undetectable PTH levels.
The goal of therapy for hypocalcemia is to treat the ____________
For hypocalcemia, one should treat the ___________, not the blood work
NO (reactions occur)
Can you give subcutaneous calcium as long-term hypocalcemia treatment?
Best long-term treatment for hypoparathyroidism/hypocalcemia
Ecclampsia may lead to _______ paralysis in cats
T/F: Phosphate enemas can be given to dehydrated cats
____ is considered a major uremic toxin
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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