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56 Cards in this Set
- Front
- Back
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normal serum ca2+ level
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8.5--10.5 mg%
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serum ca2+ exists in ___ (3) forms
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albumin bound
ionized complexed with citrate, sulfate |
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___% of serum ca2+ is bound to ___ groups on albumin
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40-45
carboxyl |
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acidosis causes increased/decreased binding of Ca2+ to albumin
this affects ___ Ca2+, but not ___ Ca2+ levels. |
decreased
ionized total |
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shift of 0.1 pH unit causes a change of ___ in ionized Ca2+
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0.16-0.2
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normal serum albumin is ___mg%. for every unit albumin below normal, add/subtract ___ units to the measured serum Ca2+.
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4
add 0.8 |
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T/F: hypercalcemia is more common than hypo
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true
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5 kinds of causes of hypercalcemia
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PTH-related
malignancy related vitamin D related bone-turnover related renal failure |
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3 kinds of PTH related causes of hypercalcemia
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primary hyper PTH
Li familial hypocalciuric hypercalcemia |
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3 kinds of primary hyper-PTH
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solitary adenoma
hyperplasia MEN |
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3 causes of hypervitaminosis D
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vitamin D intoxication
sarcoidosis idiopathic hypercalcemia of infancy |
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4 causes of high bone turnover
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hyperthyroidism
immobilization thiazides hypervitaminosis A |
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dehydration causes increased/decreased albumin, which causes increased/decreaesd corrected Ca2+
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increased
decreased |
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in hypercalcemia, first check ___, then ____. if the latter is high or normal, check ___. otherwise it's ___ or ___.
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corrected Ca2+
PTH calciuria hypervitaminosis D malignancy |
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if PTH is high or normal with low urine Ca2+, it's ___. if urine Ca2+ is high, it's ___.
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FHH
primary hyper PTH |
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if PTH is low and 1,25(OH)2D3 is high, it's ___ or ___.
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granulomatous disease (sarcoidosis)
lymphoma |
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the MEN which cause PTH hyperplasia are ___ (2)
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MEN1
MEN2A |
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in primary hyper PT, serum Ca2+ is ___, serum Pi is ___, and plasma PTH is ___.
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high
low/normal normal/high |
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in secondary hyper PT, serum Ca2+ is ___, serum Pi is ___, and plasma PTH is ___.
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low/normal
low/normal/high high/very high |
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in tertiary hyper PT, serum Ca2+ is ___, serum Pi is ___, and plasma PTH is ___.
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high
normal/high very high |
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3 CNS symptoms of hypercalcemia
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cognitive difficulties
apathy drowsiness |
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4 GI symptoms of hypercalcemia
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anorexia
nausea constipation pancreatitis |
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5 cardiovascular symptoms of hypercalcemia
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HTN
AV nodal delay short QT heart block ventricular arrhythmia |
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2 renal symptoms of hypercalcemia
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loss of concentrating ability/polyuria
nephrolithiasis |
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Ca2+ threshold for causing arrhythmia
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13
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hyper PTH can cause ____ because it increases renal ____ reabsorption
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gout
uric acid |
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criteria for PTH surgery:
serum Ca2+ > ___ urine Ca2+ > ___ CCT ___ BMD ___ age: < ___ |
1mg% above upper limit
400mg/day 30% lower than age appropriate t score below -2.5 50 |
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adenomas can be detected as ___ on Tc sestamibi scans
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hot spot
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monitoring for post surgery includes ___ twice a year and ___ once a year.
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serum calcium
BMD |
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3 locations for BMD measurement:
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lumbar spine
hip forearm |
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in PT hyperplasia, ____ of the glands are removed.
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3.5
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___% of PT surgeries fail, because of ___.
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5
undetected ectopic adenoma |
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FHH is ___. it occurs from a ___ mutation in ___. this causes ___. if the mutation is ____, the disease ____ results.
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familial hypocalciuric hypercalcemia
heterozygous LOF CaR elevated calcium set point causing increased PTH release homozygous neonatal severe hyper PT |
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NSHPT is treated by ___
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PTectomy
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____% of multiple myeloma has skeletal complications
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100
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cancers commonly metastasizing to bone
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lung
breast prostate |
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cancers which commonly cause hypercalcemia of malignancy
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lung
breast |
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PTHrP is expressed in ___ (3) in fetuses and ___ in adults.
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cartilage
hair follicles epithelia breast |
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5 tumors causing PTHrP-induced hypercalcemia
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squamous cell carcinoma
islet cell tumor adult T cell leukemia renal cell carcinoma breast carcinoma |
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5 substances released by malignant cells which cause bone resorption
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PTHrP
TGFa IL-1 TNF IL-6 |
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6 parts of treatment for hypercalcemia of malignancy
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hydration
furosemide bisphosphonates calcitonin GCs dialysis |
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bisphosphonates work against hypercalcemia by ___ing. because of ___, they must be administered by ___.
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stabilizing hydroxyapatite crystals in bone
poor GI absorption IV |
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___ is a bisphosphonate used to prevent bone resorption. standard dose is ____ per ____. dose must be adjusted to ___
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pamidronate
60-90 mg 24h renal function |
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____ is the most potent bisphosphonate
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zoledronic acid
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3 causes of hypocalcemia
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absent PTH
overwhelmed PTH ineffective PTH |
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3 causes of absent PTH
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hereditary hypo PT
acquired hypo PT hypomagnesemia |
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2 causes of overwhelmed PTH
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acute hyperphosphatemia
post-PTectomy hungry bone syndrome |
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3 causes of severe acute hyperphosphatemia
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tumor lysis
acute renal failure rhabdomyolysis |
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4 causes of ineffective PTH
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chronic renal failure
hypovitaminosis D ineffective vitamin D pseudohypoPT |
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pseudohypoPT is caused by
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PTHR1 defect
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vitamin D dependent rickets type 1 is an example of ___, whereas type 2 is an example of ___.
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hypovitaminosis D
ineffective vitamin D |
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2 CNS symptoms of hypocalcemia
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psychiatric disturbances
seizure |
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4 neuromuscular signs of hypocalcemia
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tremor
chvostek sign trousseau sign tetany |
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3 cardiac signs of hypocalcemia
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long QT
ventricular arrhythmia heart block |
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treatment for hypocalcemia is ___ or in extreme cases ___
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calcium gluconate
calcium chloride |
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familial hypercalciuric hypocalcemia is caused by ____ mutation in ___, causing ____
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GOF
CaR low PTH |
