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25 Cards in this Set
- Front
- Back
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what is the normal serum PO4 levels
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2.5-4.5
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lack of what electrolyte has potential for respiratory failure
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PO4
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what is phosphorous absoprtion dependent on
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Ca in diet
Vit D (increase absorption) PTH (decrease serum phosphate) calcitonin (decrease serum phosphate) |
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what are some causes of hypophosphatemia
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inadequate intake/absorption (phosphate binders, glucocorticoids)
internal redistribution: dextrose, insulin increased excretion: glucocorticoids |
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what are the clinical manifestations of hypophosphatemia
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respiratory arrest
CHF/cardiomyopathy b/c not enough E for heart to fxn |
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how do you tx hypophosphatemia
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oral supss: neutro phos, fleets phos (may have GI intolerance)
IV for symptomatic/critically ill: sodium phosphate or potassium phospate choice based on serum electrolyte levels |
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what is the max infusion rate for phosphorous
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7 mmol PO4/hr
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what are the causes of hyperphosphatemia
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CKD
increase intake decrease elimination IV/PO vit D PO4 laxatives |
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what is the manifestation of hyperphosphatemia
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kidney stones, hypocalcemia, tetany, soft tissue calcifications
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how do you tx hyperphosphatemia
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dietary PO4 restrictions
PO4 binders ( calcium acetate/carbonate, sevalamer, lanthonum carbonate, AlOH, MgOH) IF SEVERE SYMPTOMATIC (TETANY W/ HYPOCALCEMIA) - IV calcium salts |
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what are the normal calcium levels
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8.5-10.5 mg/dL
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what forms does Ca exist in
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ionized (unbound)
protein bound - primarily to albumin chelated fraction |
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what does Ca absorption depend on
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vit D
PTH calcitonin phosphorous |
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what are causes of hypocalcemia
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vit d deficiency
post of hypoparathyroidism hypomagnesemia hypoalbuminemia |
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when would you need to calculate for corrected Ca
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when albumin levels are low
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what meds cause hypocalcemia
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calcitonin/bisphosphonates - inhib bone resorption
those that cause Vit D deficiency - phenytoin, phenobarb |
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what are the clinical manifestation of hypocalcemia
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tetany
parethesia muscle cramps |
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how do you tx hypocalcemia
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if ACUTE SYMPTOMATIC:
IV calcium (1g CaCl2 or 2-3g CaGluconate) for 5-10 mins ASYMPTOMATIC: if due to Mg deficiency: Mg IV or PO if due to hypoparathyroidism and vit D deficiency - give oral Ca (1-3g elemental Ca), vit D supps if due to vit D defeciency - give Vit d, if pt has renal/liver failure give Calcitrol |
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what are the causes of hypercalcemia
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hyperparathyroidism
malignancies medications: Vit D/Ca supps/lithium - cause increase intake of Ca TZD/Lithium cause increase renal tubular absorption Vit A/Lithium cause increase bone resorption |
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how do you tx hypercalcemia
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make sure pt is hydrated
hydration w/ 0.9% NaCl + Loops (loops help eliminate Ca from blood) Calcitonin - rapid onset but loses effect Bisphosphonates - careful of profound hypocalcemia Glucocorticoids |
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when albumin is less than what would you use corrected Ca equation
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<4
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1 mmol KPO4 is equivalent to how many mEq of K
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1.47 mEq K
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1 mmol NaPO4 is equivalent to how many mEq Na
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1.33 mEq Na
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what lab values can cause hypocalcemia
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hypoalbuminemia
hypomagnesemia |
