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Exam 3
Dz of Ca Homeostasis
42
Veterinary Medicine
Professional
10/28/2016

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Cards

Term
What are the major hormone players in calcium metabolism?
Definition
-parathyroid hormone
-vitamin D (calcitriol)
Term
What are the major organ players in calcium metabolism?
Definition
-parathyroid glands
-kidneys
-bone
-intestine
Term
Which organ secretes parathyroid hormone? What stimulates its secretion? What inhibits its secretion?
Definition
-parathyroid glands
-Stim by dec iCa or inc P
-inh by calcitriol
Term
What does parathyroid hormone go?
Definition
-inc Ca resorption from bone and kidney
-inc activation of calcitriol: inc Ca and P absorption by intestine, kidney, and bone
-dec P resorption from kidney
Term
What is the primary source of Vitamin D? What happens to it in the liver? In the kidney?
Definition
-diet
-hydroxylation in liver: 25-hydroxyvitamin D
-hydroxylation in kidney: 1,25- dihydroxyvitamin D (aka calcitriol)
Term
What activates Vitamin D? What does it do?
Definition
-activation stim by PTH
-inc Ca and P resorption from bone, kidney, and absorption in intestine
Term
What is the purpose of calcium in the body?
Definition
-cofactor for enzymes
-cell membrane stability
-secondary intracellular messenger
-nerve conduction
-NM transmission
-muscle contraction
-smooth muscle tone
-bone formation
-glycogen metabolism
Term
What are the three types of Ca in the body? Which form(s) is/are bio active?
Definition
- ionized calcium (aka free ca), protein-bound ca, complexed ca
-ionized ca is only bio active form
Term
What are the clinical signs of hypercalcemia?
Definition
-PU/PD
-lethargy & weakness
-GI signs: vomiting, diarrhea, inappetence
-shivering
-constipation
-signs of acute kidney injury: due to calcification of renal tubules
Term
The causes of hypercalcemia is summarized by the acronym HARD IONS G?
Definition
-H: hyperparathyroidism
-A: Addison's
-R: Renal disease
-D: Vit D toxicity (especially cats)
-I: idiopathic
-O: osteolytic lesions
-N: neoplasia
-S: spurious or lab error
-G: granulomatous dz
Term
What are the common causes of hypercalcemia?
Definition
-lymphoma
-hypoadrenocorticism
-primary hyperparathyroidism
-chronic kidney dz
-idiopathic in cats
Term
What is the mechanism behind autonomous PTH secretion?
Definition
-primary hyperparathyroidism
Term
What is the physiology behind humoral hyprcalcemia of malignancy?
Definition
-PTHrP
-other factors: IL-1, TGF, TNF, etc
Term
What is the physiology behind Addison's causing hypercalcemia?
Definition
-dec calciuresis
-hemoconcentration
-inc complexed Ca
Term
What is the physiology behind hypercalcemia due to kidney dz?
Definition
-dec calciuresis
-parathyroid hyperplasia (due to inc P)
-dec inactivation of PTH
-inc complexed Ca
Term
What is the physiology behind hypercalcemia due to granulomatous dz?
Definition
-macrophages activating Vitamin D: take over the kidney's usual job
Term
What is the physiology behind hypercalcemia due to osteolytic dz?
Definition
-ca release from bone
Term
How do we treat hypercalcemia?
Definition
-treat underlying cause
-0.9% NaCl diuresis to promote calciuresis
-Furosemide: promote calciuresis
-Bisphosphonates (Pamidronate, alendronate): inh osteoclasts
-Glucocorticoids: dec inflammation and promote calciuresis
Term
Are dogs or cats more likey to have primary hyperparathyroidism? What is usually the cause? Typical age?
Definition
-dogs >>>>> cats
-parathyroid adenoma >>>>>> carcinoma
-over 7y
Term
Which dog breed is most likely toget primary hyperparathyroidism?
Definition
-Keeshond
Term
What are the clinical signs hyperparathyroidism in dogs?
Definition
-PU/PD
-listlessness
0incontinence
-weakness
-inappetence
-lower UTI
-muscle wasting
-vomiting
-shivering
-constipation
-stiff gait
Term
What are the clinical signs of hyperparathyrdoism in cats?
Definition
-anorexia
-GI signs: vomiting, diarrhea, constipation
-PU/PD
-lower urinary tract signs
-neuro signs
Term
What diagnostic tests do we run on hyperparathyroidism?
Definition
-physical exam: rule out other causes of hypercalcemia
-CBC: normal
-UA
Term
What does a UA show for hypercalcemia due to hyperparathyroidism?
Definition
-hematuria
-pyuria
-bacteriuria
Term
What results do we see on biochem analysis for hypercalcemia due to hyperparathyroidism?
Definition
-hypercalcemia
-hypophosphatemia
-azotemia is uncommon
Term
What definitively diagnoses hyperparathyroidism?
Definition
-paired PTH and ionized Ca: inc ionized Ca, inc/normal PTH, PTHrP negative
Term
What is the significance of PTHrP being positive?
Definition
-highly suggestive of cancer
Term
What do we see on US that diagnoses hyperparathrydoism?
Definition
-abnormal parathyroid gland(s)
Term
What are our three forms of hyperparathyroidism treatment?
Definition
-Parathyroidectomy: most only have one abnormal parathyroid gland
-percutaneous US guided RF ablation: heat destroys parathyroid gland
-percutaneous US guided ethanol ablation: ethanol destroys parathyroid gland
Term
What are the major components of post-treatment management for hyperparathyroidism?
Definition
-normal parathyroid gland atrophied
-oral calcitriol
-oral calcium supplementation
Term
What is hungry bone syndrome? How do we treat it?
Definition
-rebound syndrome that occurs due to chronic severe hypercalcemia where the bone starts resorbing all the calcium in the body
-treat with prolonged calcitriol and Ca supplementation
Term
What are the clinical sings of hypocalcemia?
Definition
-facial pruritus
-panting
-seuzures
0muscle fascicualtions
-hypertherma (due to m fasciculations)
-myalgia
-stiff gait
-nervousness
-GI signs: anorexia, vomiting, diarrhea
Term
Out of the clinical signs that occur due to hypocalcemia, which do not occur with hypercalcemia?
Definition
-seizures and stiff gait
Term
What are the common causes of hypocalcemia?
Definition
-primary hypoparathyroidism
-eclampsie: small mom + big litter + poor nutrition
-kidney disease
-acute pancreatitis: common in cats
-intestial dz
-hypomagnesemia: causes hypoparathyroidism
-hypoproteinemia: only affects protein-bound Ca
-prolonged urethral obstruction: cat
-phosphate enemas
-ethylene glycol toxicity
-massive blood transfusions: anticoagulant binds Ca
Term
How do we treat emergency hypocalcemia?
Definition
-10% calcium gluconate IV over 20 mins
-monitor ECG during infusion: watch for bradycardia, VPCs, shortened Q-t interval
-recheck blood Ca and redose if necessary
Term
Describe the physiology behind prmar hypoparathyroidism.
Definition
-immune mediated destruction of glands
-also occurs with neck trauma or surgery
Term
Is primary hypoparathryoidism more common in dogs or cats?
Definition
-dogs
Term
What is the typical signalment of a dog with primary hypoparathyroidism?
Definition
-around 5y
-60% female
-breed: tory poodle, lab, mini Schnauzer, GSD, terriers
Term
What are the clinical signs in a dog with hypoparathyroidism?
Definition
-seizure
-hyperthermia
-tense abdomen
-stiff gait
-muscle fasciculations
Term
What do we see in lab data of dog with hypoparathyroidism?
Definition
-dec Ca and inc P
-CBC and UA are normal
Term
How can we definitively diagnose hypoparathyroidism in a dog?
Definition
-dec ionized Ca and dec PTH
Term
How do we medically maintain hypoparathyroidism?
Definition
-oral calcitriol: BID
-oral calcium (tums): don't need long-term if they are on a good diet
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