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31 Cards in this Set
- Front
- Back
nl total serum Ca
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8.5 - 10.5
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nl ionized Ca
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4.4 - 5.4
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calc corrected calcium
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(obs Ca + .8)*(4 - obs alb)
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wat are the 3 main regulators of normal ca intake and maintence?
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kidney
bone intestines |
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____ is the most important hormone regulator of [Ca] in the serum
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parathyroid hormone
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important ions and parts of Ca reabsorption in the the nephron
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-50-70% of Ca is reabsorbed in the proximal tubules that are NA-DEPENDENT DOE
-PTH reabsorbeds Ca in the DT and Collecting duct -30-40% of Ca reabsorbed in the loop of henle. loop diuretics/furesomide prevent Ca reabsoption |
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what lab should order for a pt who is in an alkalotic / acidotic state?
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ionized Ca lab
alkalosis - dec ionized Ca. more alb-ca acidotic - inc ionized Ca. less Ca bound to alb |
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nl for vitamin 25(OH)D serum levels
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nl 30-80 ng/mL
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wat are the vitD conversions of calcitriol, doxeralciferol, paricalcitol
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calcitriol - 1mcg
-2 to 1 doxercalciferol - 2mcg -2 to 1 paricalcitol - 4mcg paricalcitol or calcitriol 4:1 |
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tx of acute hypocalcemia
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-200-300mg elemental CaIV bolus over 5-10mins til stms resolve
-elemental Ca .5 - 2 mg/kg/hr until ionized Ca resolves .3 - .5 mg/kg/hr infusion to maintain Ca monitor ionized Ca until resolved |
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how much elemental Ca is in CaCO3 1250 mg
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500mg, 40%
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how much elemental Ca is in CaAcetate 667 mg
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169mg, 25%
want to give 1-2 gm elemental Ca / day outside of meals in divided doses...at least 1.5 hrs |
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DI hypercalcemia causes
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thiazides
lithium anti-estrogens vitD, A toxicity |
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tx hypercalcemia and when?
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cincaclet to dec [PTH] and Ca when iPTH >300 pg/mL and corrected Ca >8.4 mg/dL
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wat to expect and when to adjust cinacalcet?
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anticipate 10% dec in [Ca]
-obtain 1-2 weeks after initiation or dose increase |
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tx for emergent hypercalcemia
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-hydrate with NS
-furosemide -monitor Ca, PTH, Na, Mg, K -Calcitonin in CHF or non-responders to saline/furosemide --must use test dose first doe |
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tx hypercalcemia bc of malignancy?
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rehydrate
-use bisphosphonates --monitor for nephrotoxictity; Scr, jaw osteonecrosis --PO4, Mg, Ca |
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tx for chronic hypercalcemia
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chronic hypercalcemia with corticosteroids by dec Ca, GI absorption by inhibiting vit D activation
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minute shifts of organic P between ECF <--> inctracellular cause _______
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profound changes in P levels
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nl serum P
varying factors |
2.5 - 4.5 mg/dL
-can vary diurnally through insulin and carbs |
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PO4 things need to look up frequently
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-mmol conversion to meQ and elemental P
-administration of IV PO4 repletion -PO replacement therapy with PO4 |
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______ most important regulator of serum P
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kidneys most important regulator of serum P
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wat happens to PO4 in CKD / 2nd hyper-PTH
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PTH not stimulating kidneys to excrete P by blocking reabsorption.
-have high Phosphate levels |
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wat happens to PO4 in primary hypo-PTH
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dec PTH, not stimulating PO4 urinary excretion.
- have high phosphate levels |
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wat happens to PO4 in primary hyperparathyroidism
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PTH causes inc in urinary P excretion and decreases P serum
- have low PO4 levels |
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wat conditions of hypophosphatemia, do not tx
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diabetica ketoacidosis / DKA
nonketotic hyperglcemia NKH |
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wat level and usually see with cells with hypophosphohatemia
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PO4 < 1 mg/dL
high turnover cells like RBC / WBC |
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administer caution with PO4 IV repletion
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administer slow n low....over 6 hrs
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when to lower / hold dose adjustments to PO4
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Ca > 12 mg/dL. hold PO4 bc calcifications can occur
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amt of PO4 to add to TPNs to prevent refeding syndrome
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15mmol of PO4 / L OR per 1,000 calories of dextrose
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goals of KDOQI P binder use
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P < 5.5 mg / dL (stage 5).... want <5.5
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