Term
| What are the normal calcium values for a dog and cat? |
|
Definition
Dog: 9.0-11.7
Cat: 8.0-10.5 mg/dl |
|
|
Term
| Total calcium can be broken down into protein bound at ____%, complexed at _____%, and ionized at ____%. The biologically active form is the __________ calcium. |
|
Definition
|
|
Term
| Normal ionized calcium levels are: |
|
Definition
4.6-5.6 mg/dl (dog)
4.5-5.5 mg/dl (cat) |
|
|
Term
| Ionized calcium is affected by acid base status. Alkalosis _________ ionized calcium, while acidosis ___________ ionized calcium. |
|
Definition
|
|
Term
| T/F: ionized calcium levels are affected by hypoalbuminemia. |
|
Definition
| False. The total serum calcium level will decrease and protein-bound forms decrease. |
|
|
Term
| What are the correction formulas to adjust for ionized calcium? |
|
Definition
Calcium - albumin + 3.5
(0.4) (total protein) + 3.3 |
|
|
Term
| Calcitonin is produced in the __________ cells of the ___________ gland and is released in response to ____________. It's overall effect is to _____________ calcium levels, __________ PTH effect on bone, and ______________ renal resorption of calcium. |
|
Definition
C cells (parafollicular)
Thyroid
Decrease
Inhibit
Decrease |
|
|
Term
| T/F: calcitonin levels are directly measured. |
|
Definition
|
|
Term
| The active form of vitamin D is _________________, also known as ___________. Conversion to the active form occurs in the ____________ in response to ______________. The overall effect of vitamin D is to ______________ calcium levels, ______________ intestinal absorption of calcium, and may help facilitate PTH effect on bone. |
|
Definition
1,25 dihydroxycholecalciferol
Calcitriol (vitamin D3)
Kidney
Hypocalcemia
Increase
Increase |
|
|
Term
| T/F: vitamin D levels can be measured. |
|
Definition
|
|
Term
| Parathyroid hormone is responsible for what type of calcium regulation? |
|
Definition
|
|
Term
| Parathyroid hormone comes from the _________ gland. If blood calcium levels fall, PTH ___________ and if blood calcium levels increase, PTH ___________. PTH results in ____________ blood calcium and ____________ blood phosphorous. Its actions include mobilizing calcium from ________, increasing vitamin D conversion in the ___________, increasing ____________ uptake of calcium, increasing ______________ resorption of calcium, and ______________ renal phosphorous excretion. |
|
Definition
Parathyroid
Increases
Decreases
Increased
Decreased
Bone
Kidney
Intestinal
Tubular
Increase |
|
|
Term
| What hormone determines the set point for PTH? |
|
Definition
|
|
Term
| T/F: phosphorous directly affects PTH levels. |
|
Definition
| False. It has a reciprocal relationship with calcium, so if phosphorous increases, then calcium levels will decrease. These decreased calcium levels stimulate PTH. |
|
|
Term
| What are the systemic effects of calcium? |
|
Definition
Bone formation
Muscular activity
Cardiac function
Cellular biochemistry/signaling
Coagulation factor |
|
|
Term
| With hypercalcemia, blood ionized calcium levels ___________, PTH levels ___________, vitamin D conversion ____________, calcium resorption from the GI tract ___________, renal calcium excretion ___________, calcium is/is not deposited in bone, and the overall effect is to ____________________________ (phrase). |
|
Definition
Increase
Decrease
Stops
Increases
Is
Bring calcium back to normal |
|
|
Term
| What are the etiologies of hypercalcemia? (Acronym) |
|
Definition
Hyperparathyroidism
Addison's disease
Renal disease
Hypervitaminosis D
Idiopathic
Osteolysis
Neoplasia
Systemic granulomatous disease |
|
|
Term
| What are the clinical signs of hypercalcemia? |
|
Definition
PU/PD
Listlessness
Urinary incontinence
Weakness/exercise intolerance
Inappetance |
|
|
Term
| T/F: when hypercalcemia is identified on a minimum database, it should always be double checked. |
|
Definition
True
A general approach to hypercalcemia:
1. Complete history
2. Physical exam
3. MDB
4. Check ionized calcium
5. Survey thoracic/abdominal rads
6. Abdominal ultrasound |
|
|
Term
| What diagnostics should be performed when doing a specific approach to hypercalcemia? |
|
Definition
Lymph node aspiration
Bone marrow evaluation
PTH/hypercalcemia of malignancy/vitamin D panel |
|
|
Term
| What does a PTH level/hypercalcemia of malignancy/Vitamin D panel measure? |
|
Definition
1. PTH
2. PTH-rp
3. Ionized calcium level
4. Vitamin D level |
|
|
Term
| What are the etiologies of hyperparathyroidism? |
|
Definition
Parathyroid adenoma
Adenomatous hyperplasia
Parathyroid carcinoma |
|
|
Term
| With hyperparathyroidism, PTH secretion is not suppressed by hypercalcemia because normal negative feedback is ________. Therefore, hyperparathyroidism is characterized by ________ total calcium, ________ ionized calcium, and _________ PTH. |
|
Definition
|
|
Term
| Which canine breed is overrepresented by hyperparathyroidism? |
|
Definition
|
|
Term
| The clinical signs of hyperparathyroidism are solely due to _______________. |
|
Definition
|
|
Term
| List the clinical signs of hyperparathyroidism: |
|
Definition
PU/PD
Listlessness/lethargy/muscle weakness
Incontinence
Urinary tract signs
Vomiting/constipation/shivering
Stiff/stilted gait |
|
|
Term
| How can hyperparathyroidism be diagnosed? |
|
Definition
Parathyroid mass not usually palpable
Complete history/PE/MDB
Elevated PTH in face of hypercalcemia
Cervical ultrasound
Nuclear scintigraphy
Cervical CT/MRI |
|
|
Term
| As a general rule, with hypercalcemia, the phosphorous calcium product should be determined. If the product is over ____, then soft tissue calcification can occur and is an indication for immediate therapy. |
|
Definition
|
|
Term
| List the therapy for hypercalcemia: |
|
Definition
IV fluid therapy--saline diuresis @ 2-3 times maintenance
Diuretics (furosemide) AFTER fluid deficits have been replaced
Glucocorticoids AFTER diagnosis has been made
Surgical removal
Percutaneous ultrasound guided ablation |
|
|
Term
| Prior to definitive therapy for hyperparathyroidism, look at the calcium level. The higher the calcium, the greater the chance for the development of clinically significant post-operative _____________. If presurgical calcium > _________, begin vitamin D therapy prior to surgery. If presurgical calcium >_________, begin vitamin D therapy 2-3 days before surgery. |
|
Definition
Hypocalcemia
14 mg/dl
18 mg/dl |
|
|
Term
| T/F: calcium levels should always be monitored postoperatively in a patient with hyperparathyroidism. |
|
Definition
|
|
Term
| Hypercalcemia of malignancy is most commonly associated with what in dogs? |
|
Definition
Lymphoma
Anal sac adenocarcinoma |
|
|
Term
| Hypercalcemia of malignancy is most commonly associated with what in cats? |
|
Definition
Lymphoma
Squamous cell carcinoma |
|
|
Term
| The most common cause for pathologic hypercalcemia is _____________. |
|
Definition
|
|
Term
|
Definition
| PTHrp is secreted by tumor tissue and is responsible for humeral hypercalcemia. The hypercalcemia may be intermittent and PTHrp can be differentiated from PTH by a profile done by Michigan State. |
|
|
Term
| What three conditions cause the most severe hypercalcemia? |
|
Definition
Malignancy
Hyperparathyroidism
Hypervitaminosis D |
|
|
Term
| What can cause hypervitaminosis D? |
|
Definition
Rodenticides
Human psoriasis medications
Some plants
Iatrogenic sources
Note: 10 mg/kg of rodenticide orally can be lethal |
|
|
Term
| What are the systemic effects of hypervitaminosis D? |
|
Definition
Increased bone resorption
Increased GI calcium absorption
Increased GI phosphorous absorption |
|
|
Term
| How can hypervitaminosis D be diagnosed? |
|
Definition
|
|
Term
| What are the recommended therapies for hypervitaminosis D? |
|
Definition
Treat hypercalcemia
Remove source (may require GI removal)
Salmon calcitonin |
|
|
Term
| As blood calcium decreases, PTH should _____________, which stimulates _________________ conversion, to ____________ GI calcium absorption, _____________ renal calcium excretion, calcium is/is not mobilized from bone, ____________ phosphorous excretion via the kidneys, and the overall effect is to make ______________________ (phrase). |
|
Definition
Increase
1,25 dihydroxycholecalciferol
Increase
Decrease
Is
Increases
Calcium levels rise |
|
|
Term
| What are the etiologies of hypocalcemia (acronym)? |
|
Definition
Lack of PTH
Eclampsia
Acute renal failure
Nutritional
Chronic renal failure
Hypoalbuminemia
Acute pancreatitis
Phosphate enemas |
|
|
Term
| What are the etiologies for a lack of PTH associated with hypocalcemia? |
|
Definition
Iatrogenic with thyroidectomy (cats)
Parathyroidectomy (dogs)
Primary immune-mediated destruction |
|
|
Term
| For primary immune-mediated destruction of the parathyroid gland, __________ are overrepresented, the average age is ______, and males/females are at a greater risk. |
|
Definition
|
|
Term
| T/F: a lack of PTH is rare in cats. |
|
Definition
|
|
Term
| What are the clinical signs of hypocalcemia? |
|
Definition
Seizures/tetany
Fever (often d/t increased muscle activity from seizures/tetany)
Tense abdomen/stiff gait/muscle fasciculations
Cardiac arrhythmias
Facial pruritus
Chewing on paws
Thin/weight loss |
|
|
Term
| What are the three differentials for facial pruritus? |
|
Definition
Hypocalcemia
Methimazole reaction (cats)
Pseudorabies (dogs) |
|
|
Term
| Most dogs with hypocalcemia present with acute/chronic signs. |
|
Definition
|
|
Term
| There is a high index of suspicion for hypoparathyroidism when what four parameters are met? |
|
Definition
1. hypocalcemia
2. hypomagnesemia
3. hyperphosphatemia
4. normal renal parameters |
|
|
Term
| What is the "nail in the coffin" of hypoparathyroidism? |
|
Definition
| Low to undetectable PTH levels in a hypocalcemic animal. |
|
|
Term
| What is the goal of therapy for hypocalcemia? |
|
Definition
| Want to increase calcium levels smoothly and gradually to a point where clinical signs are abolished (generally when total calcium >6-7 mg/dl and ionized calcium >0.6-0.7 mmol/L |
|
|
Term
| What is the emergency therapy for hypocalcemia? |
|
Definition
IV calcium administration with concurrent ECG monitoring
Give 10% calcium gluconate slowly |
|
|
Term
| T/F: body temperature of animals with hypocalcemia should be monitored, as most require external cooling. |
|
Definition
| False. Most animals do not require external cooling. |
|
|
Term
| What is the chronic therapy for hypocallcemia? |
|
Definition
IV infusion until stable--repeated boluses are not recommended (do a continuous infusion)
Change to DILUTED (1 part calcium:2-4 parts saline) subcutaneous calcium at 60-90 mg/kg/day
Oral supplementation of calcium carbonate (tums @ 1-4 g/day divided) or Vitamin D3 (calcitriol @ 20-40 ng/kg/day for loading dose and then 10-20 ng/kg/day for maintenance--note that NANOGRAMS) |
|
|
Term
| Eclampsia is most common in large/small dogs. |
|
Definition
|
|
Term
| Cats with eclampsia may show _______________ as opposed to stiffness and muscular fasciculations. |
|
Definition
|
|
Term
| Nutritional hypocalcemia is caused when foods such as __________ have a low _____ ratio. |
|
Definition
|
|
Term
| T/F: with nutritionally induced hypocalcemia, blood calcium and phosphorous levels may be normal or close to normal. |
|
Definition
|
|
Term
| What are some side effects of nurtitional hypocalcemia? |
|
Definition
| Pathologic fractures d/t bone resorption in chronic disease |
|
|
Term
| T/F: phosphate enemas can be given to cats. |
|
Definition
| False--especially not dehydrated cats. |
|
|
Term
| How does ethylene glycol toxicity cause hypocalcemia? |
|
Definition
| Ethylene glycol causes systemic chelation of calcium ions, resulting in hypocalcemia |
|
|
Term
| T/F: hypocalcemia in acute pancreatitis is usually severe and life-threatening. |
|
Definition
| False: usually mild and clinically insifnificant |
|
|
Term
| T/F: renal secondary hyperparathyroidism is a process. |
|
Definition
|
|
Term
| _____ is considered a major uremic toxin. |
|
Definition
|
|
Term
| What are the etiologies of renal secondary hyperparathyroidism? |
|
Definition
Decreased GFR from renal disease
Decrease in functional renal tissue |
|
|
Term
| Describe the mechanism behind renal 2 hyperparathyroidism d/t decreased GFR/renal disease: |
|
Definition
| Decreased GFR-->hyperphosphatemia-->phosphorous goes up, calcium goes down-->PTH stimulated |
|
|
Term
| Describe the mechanism behind renal 2 hyperparathyroidism d/t a decrease in functional renal tissue: |
|
Definition
Decreased conversion of 1,25 dihydroxycholecalciferol-->loss of GI calcium absorption
Decreased GFR results in decreased clearance of PTH fragments |
|
|
Term
| What is the clinical presentation of renal 2 hyperparathyroidism? |
|
Definition
Fibrous osteodystrophy (rubber jaw)
Cellular toxicity |
|
|
Term
| What is the therapy for renal 2 hyperparathyroidism? |
|
Definition
Treat CRF--dietary P restriction, GI P binders
Calcitriol therapy to reduce PTH levels near normal (Calcitriol @ 2.5-3.5 ng/kg PO daily); be sure to monitor PTH levels and blood calcium levels |
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