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What gland is responsible for homeostasis Ca?
parathyroid glad
thyroid
Where is the greatest concentration of Ca found?
in the ECF
What are the different percentages associated with the availability of Ca?
Ionized in the plasma 50%
protein bound 41%
complexed to an anion 9%
Which of the partitions of Ca in the body is the active form?
Ionized
Acute acidemia will ______ the ionized Ca? (increase/decrease)
increase
Acute acidemia will ______ the ionized Ca? (increase/decrease)
decrease
What is Ca important for?
the plateau portion of the cardiac action potential
Excitation contraction of muscles both cardiac and skeletal
involved in neurotransmitter release
secretion of enzymes and hormones
Important to bones
What is hypoCa?
ionized Ca <4 mEq/Dl or 2 mEq/L
What usually causes hypoCa?
dysfunction of the parathyroid gland
surgical removal of thyroid
increased or decreased levels of Mg
increased phos levels
lysis of cells from chemo
Cell destruction from rhabdo
When we give a lot of RBC's what happens with the Ca level?
decreased due to the action of citrate chelating Ca.
In what cases would the citrate left behind by transfusions precipitate in cardiac abnormalities?
a pt with renal or liver disease
What are some instances that might decrease Ca levels?
massive transfusions
hypothermia
excess sodium bicarbonate
What patients are especially prone to develop hypoCa?
80% of critically Ill Pt's
25% of non-ICU pt's
What signs point to Ca abnormalities in pts?
Chvostik's sign tapping on the facial nerve causes spasms of the lips
trousseau's sign inflate cuff 20 mmHg above systolic and you would see spasms
How is the differential diagnosis made?
Age of the pt
The serum phos
general clinical status
duration of hypoCa
What level if drawn on a pt might indicate VitD deficiency?
Hypo Ca in lieu of Low phos
In a pt whit chronic low Ca, what is the most likely cause of low CA?
hypoparathyroidism
How do we normally treat hypoCa?
treat underlying cause
Correct other lyte abnormalities
What other lyte imbalances will potentate cardiac or neuro changes with hypoCa?
hyperK
HypoMag
Do we get really concerned with mild hypoCa?
not really, don't want to overtreat it
What is an acute treatment of hyopCa?
CaChloride
Cagluconate
Explain the rule of 10's when treating hypo Ca?
10ml of 10% Cagluconate over 10 minutes. followed by an infusion
Why do we administer Vit D with a hypoCa pt?
increase the Ca uptake
What is hyper Ca?
ionized Ca >3 mEq/L 1.5 mmol/L
serum Ca > 10.5 mg/dl
Under what level of total Ca are pt's usually not symptomatic?
11.5
What is the treatment of hyper Ca?
treat the underlying cause
What is the acute treatment of Ca?
Dilute the Ca with NS
Ca above what level is a medical emergency?
14 mg/dl
What do you do if the Ca is >14?
hydrate the pt
correct other lyte abnormalities
Lasix will help excrete Ca and increase uop
Calcitonin
What is calcitonin?
Hormone secreted by parathyroids
More effective if given with glucocorticoids i.e.cortisol
Will have an effect 24-48 hrs, but is not a very great effect
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Author
marshenski
ID
210257
Card Set
Ca++
Description
BC Boston College CRNA Chem:lytes
Updated
2013-03-29T21:53:05Z
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