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43 Cards in this Set
- Front
- Back
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PTH
-systemic effects |
-inc. calcium and phosphorus mobilization from bone
-inc. phosphorus excretion and dec. calcium excretion by kidney -stimulate 1,25 Vit. D production by kidney --inc. calcium and phosphorus absorption from GI --inc. calcium and phosphorus mobilization from bone |
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ECF calcium
-compartments |
-ionized 45%
-protein bound 50% -complexed 5% |
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Calcium
-essential for? |
Normal cell function
-neurons -skeletal myocytes -smooth myocytes |
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Primary hyperparathyroidism
-signalment |
-Occurs in dogs and cats
-very rare in cats |
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Primary hyperparathyroidism
-causes |
-adenoma (most common) - solitary nodule
-hyperplasia -adenocarcinoma |
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Main characteristic of hyperparathyroidism
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-hypercalcemia
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Hypercalcemia
-differentials |
-hypercalcemia of malignancy
-hypoadrenocorticism -idiopathic hypercalcemia of cats -hypervitaminosis D -chronic renal failure -Misc. -Lab error |
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Most common cause of hypercalcemia in dogs
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-hypercalcemia of malignancy
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Hypercalcemia of malignancy
-causes |
Osteolysis
-multiple myeloma -leukemia PTHrp Production -lymphosarcoma -multiple myeloma -apocrine gland carcinoma -mammary adenocarcinoma |
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Hypoadrenocorticism
-aka |
-Addisons disease
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Hypervitaminosis D
-characteristic lab data |
-hypercalcemia & hyperphosphatemia
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Hypervitaminosis D
-causes |
-cholecalciferol rodenticide toxicity
-ingest Vit. D containing drugs -plants |
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Lab errors causing hypercalcemia
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-lipemia
-hemolysis -hemoconcentration |
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Hypercalcemia
-main clinical signs in dogs |
-polyuria
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Hypercalcemia
-main clinical signs in cats |
-GI signs
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Hypercalcemia
-overall clinical signs |
GI
-anorexia -vomiting -constipation -pancreatitis Renal Signs -PU/PD -pollakuria Neurologic Signs -mental dullness -obtundation |
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Pollakiuria
-definition |
-increased frequency of urination due to obstruction (typically small stones) only allowing small amount of fluid out at once, forcing urination to occur more frequently
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Hyperparathyroidism
-physical exam |
-possibly able to palpate slightly enlarged parathryroid gland, but unlikely
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Hyperparathyroidism
-diagnostic imaging |
-can use ultrasound but not diagnostic
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Hyperparathyroidism
-typical lab findings |
-hypercalcemia (inc. total Calcium, inc. ionized Calcium)
-dec. phosphorus |
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Parathyroid panel
-measures what values |
-PTH
-ionized Calcium -PTHrp -Vit D |
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Parathyroid Panel
results for primary hyperparathyroidism |
-PTH: inc.
-iCa: Inc. -PTHrp: Dec. -Vit D: Inc. |
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Parathyroid Panel
-results for lymphosarcoma |
-PTH: dec.
-iCa: inc. -PTHrp: inc. -Vit D: dec. |
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Parathyroid panel
-results for chronic renal failure |
-PTH: inc.
-iCa: dec. -PTHrp: ? -VitD: dec. |
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Parathyroid panel
-results for hypervitaminosis D |
-PTH: dec.
-iCa: inc. -PTHrp: dec -VitD: inc. |
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Parathyroid Panel
-results for idiopathic hypercalcemia |
-PTH: N-dec
-iCa: Inc. -PTHrp: N -Vit D: N |
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Hyperparathyroidism
-non-specific treatment goal |
-just knock down the Ca level
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Hyperparathyroidism
-non-specific treatment |
-Sodium chloride (0.9%) --> saline diuresis
-Furosemide (promote Na+ loss) -Glucocorticoid (calcium excretion) |
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Hyperparathyroidism
-specific treatment |
-bisphosphonates (inhibit osteoclast activity, nephrotoxicity)
-calcitonin emergency treatment of Vit D (cholecalciferol) toxicity) |
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Hyperparathyroidism
-definitive therapy |
-surgical removal of affected gland with post-op monitoring of ionized Ca levels
-pre-op administration of calcitriol may help in preventing the post-op hypocalcemia -ablation possible but may not be definitive and can have complications |
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Primary hyperparathyroidism
-prognosis |
-excellent with surgical treatment
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Primary hypoparathyroidism
-signalment |
-uncommon in cats and dogs
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Primary hypoparathyroidism
-etiology |
-lymphocytic parathyroiditis
-iatrogenic damage/removal -parathyroid surgery |
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Primary hypoparathyroidism
-characteristic sign -other signs |
-hypocalcemia
-dec PTH -inc. serum phosphorus |
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Hypocalcemia
-physiological manifestations/signs |
-tetany
-muscle cramping -ataxia -cardiac changes (dec. systolic function, cardiac dilation, myocardial irritability, bradycardia) -CNS dysfunction (restlessness, depression, seizures) |
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Tetany
-definition |
-periodic painful muscle spasms
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Hypocalcemia
-diagnosis |
-low total Ca
-low ionized Ca |
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Hypocalcemia
-differentials |
-hypoalbuminemia* (ionized Ca usually unaffected)
-primary hypoparathyroidism -chronic renal failure (dec. 1,25 vit D prod) -acute pancreatitis (Ca complex with peripancreatic fat) -lymphangiectasia (poor intestinal absorption of Ca, Vit D) -eclampsia (lactating dam [usually small dogs]; siezuring) -ethylene glycol toxicity (hyperphosphatemia and calcium chelation from metabolites) -nutrition (all meat diet) [-hyperphosphatemia |
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Parathyroid panel
-Hypoparathyroid values |
-PTH: dec.
-iCa: dec. -PTHrp: dec. -Vit D: dec. |
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Hypocalcemia
-emergency treatment |
-Calcium gluconate (10% IV)
-discontinue if bradycardia occurs |
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Hypocalcemia
-Immediate maintenance therapy |
-No repeated IV bolus
-SubQ Ca: Calcium Gluconate (6-8hr) -DILUTE!! -maintain total Ca above 8 mg/dl or -CRI: 60-90 mg/kg/day Calcium gluconate (10%) |
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Hypocalcemia
-long term maintenance therapy |
-Vit D2 (ergocalciferol)
-Calcitriol ($$$) -Oral calcium supplements (administered early in treatment) |
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Calcium chloride
-why not used to treat hypocalcemia |
Caustic
-necrosis -skin sloughing -calcinosis cutis |
