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Parathyroid hormone (PTH) is produced primarily in response to __________, and its net effect is increased _________ and _________ and decreased __________. It also stimulates ________ production.
hypocalcemia; serum calcium; renal excretion of phosphorous; serum phosphorous; vitamin D
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Vitamin D production is stimulated by _________; vitamin D increases ___________.
PTH; serum calcium
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The principal regulator of blood calcium levels.
parathyroid hormone (PTH)
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How does vitamin D increase serum calcium levels?
it increases the GI absorption of calcium
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Samples must be analyzed promptly to get accurate free Ca2+ measurements because these levels are dependent upon _______.
pH, which changes with exposure to air
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Measured serum calcium will be decreased if __________ is decreased.
serum albumin
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What are the most common causes for hypocalcemia? (5)
hypoalbuminemia, critical care patients, CKD, milk fever, pancreatitis
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Most common causes of hypercalcemia? (5)
neoplasia, bone growth/remodeling (young animal or animal with fracture/broken bone), renal disease and Addison's disease (decreased urinary excretion), dehydration
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Hypophosphatemia can cause ____________.
hemolytic anemia
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3 main causes of hypophosphatemia.
increased excretion (hyperparahtyroidism), alkalosis (shift from ECF to ICF), decreased absorption/mobilization
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4 main causes for hyperphosphatemia.
decreased renal excretion (decreased GFR, rupture), acidosis (shift from ICF to ECF), increased absorption/ mobilization, bone growth
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Serum magnesium depends on __________; decreased Mg is associated with... (6)
intake; insufficient intake, critical illness, diabetes mellitus, lactation, enteropathy, hypoparathyroidism
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Hyperalbuminemia is always associated with _________.
dehydration
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Causes of hypoalbuminemia. (6)
decreased production (liver disease, malabsorption, compensatory), increased loss (renal loss, enteropathy, blood loss)
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Causes of hyperglobulinemia. (3)
inflammation, neoplasia (plasma cell neoplasia (myeloma), lymphocytic leukemia)
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Causes of hypoglobulinemia. (2)
FTPI, congenital immunodeficiency (SCID)
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Increased fibrinogen can be due to... (2)
dehydration or inflammation
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A PP:fibrinogen ratio of >15 indicates...
dehydration
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A PP: fibrinogen ratio of <10 indicates...
inflammation
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A PP: fibrinogen ratio between 10-15 indicates...
combination? need to consider other data and clinical signs
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5 common causes of hypercholesterolemia.
postprandial, nephrotic syndrome (protein is lost and cholesterol increases to maintain oncotic pressure), hypothyroidism, diabetes mellitus, cholestasis
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3 causes of hypocholesteroliemia.
portosystemic shunts/vascular anomalies, protein-losing enteropathy, hypoadrenocorticism
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7 Causes of hypertriglyeridemia.
postprandial, hypothyroidism, nephrotic syndrome, acute pancreatitis, diabetes mellitus, Cushing's disease, diet
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Total body water in normally about ______ of body weight.
60%
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Decreased total body water indicates ________.
dehydration
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TBW is divided into two categories:
extracellular fluid (ECF= blood, intercellular fluid, GI tract, and transcellular fluid) and intracellular fluid (ICF)
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The number of solute particles per unit weight of a solution.
serum osmolality
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In normal animals, _________ is the primary driver of osmolality.
sodium
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An increase osmo gap indicates the presence of...
small unmeasured molecules, such as exogenous toxins
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Hyperosmolality induces shift from ______ to ______, and rapid correction of this may cause __________.
ICF to ECF; cellular edema
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Loss of ICF results in _______; shift to ECF may mask _______; both are associated with ________.
cell shrinkage; dehydration; hyperosmolality
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Hypoosmolality induces shift from ______ to ______, which can compound ____________.
ECF to ICF; dehydration
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Increase ICF results in ________, which may cause _________; this is associated with _________.
cell swelling; intravascular hemolysis; hypoosmolality
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ECF has high levels of _____ and _____, but low levels of _______ [electrolytes].
Na+; Cl-; K+
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Bicarbonate is generated in the ________, ________, and _______.
lungs (primarily); gastric mucosa; RBCs
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Causes of hypernatremia (increased sodium). (6)
water deficit, water loss greater than sodium loss (GI osmotic shifts, renal excessive urine production), sodium excess (iatrogenic or salt poisoning), artifact
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Causes of hyponatermia (reduced sodium). (9)
pseudohyponatermia (lipemic samples), sodium deficit (vomiting, diarrhea, renal loss (hypoadrenocorticism), sweating in horses, salivary loss, uroabdomen), water excess
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4 causes for hyperchloremia.
hypernatremia (same differentials), potassium bromide therapy, excessive loss, chloride retention (renal acidosis)
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If chloride is low and sodium is normal or the decrease in chloride is greater than the decrease in sodium, consider... (4)
vomiting, displaced abomasum, obstruction, bovine renal failure
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Hyperkalemia can be caused by the following 3 general mechanisms:
shifting K+ from ICF to ECF, increased total body K+, pseudohyperkalemia
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Shifting K+ from ICF to ECF occurs with ________.
metabolic alkalosis
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Increased total body K+ occurs with... (3)
acute renal failure, urinary tract obstruction or leakage, addison's disease
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Pseudohyperkalemia occurs with... (3)
thrombocytosis, hemolysis, marked leukocytosis
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Hypokalemis has the following 3 general causes (mechanisms):
decreased intake, increased loss/excretion, shifting from ECF to ICF
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Increased loss/ excretion of K+ occurs with... (5)
vomiting/diarrhea, CKD, diuresis, diabetic ketoacidosis, cutaneous loss (sweating in horses)
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Shifting of K+ from ECF to ICF occurs with _______.
mild alkalemia
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Na/K ratio is used to help diagnose ____________
hypoadrencorticism (Addison's disease) [reduced Na/K]
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Increased bicarbonate concentrations is usually associated with _______________; it is usually due to... (4)
metabolic alkalosis; gastric loss/vomiting, gastric sequestration of HCl, renal loss, compensation for chronic respiratory acidosis
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Decreased bicarbonate concentrations are usually associated with ___________; they can be caused by... (6)
metabolic acidosis; [with increased anion gap] ketoacidosis, lactic acidosis, renal insufficiency, uroabdomen/rupture, [with normal anion gap] diarrhea/vomiting, saliva
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Most changes in the anion gap are due to ____________________.
increased unmeasured anions
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5 causes of increased anion gap.
delayed sample analysis, renal insufficiency/failure, diabetes mellitus ketoacidosis, toxicity (ethylene glycol, salicylates)
LUKES (lactic, ketones, ethylene glycol, salicylates)
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In lactic acidosis, you would expect to see a decrease in ___________ and an increase in _________.
bicarbonate; anion gap
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Increased lactate occurs with... (3)
decreased O2 delivery due to hypoxia/hypoperfusion, altered carbohydrate metabolism (liver, kidney, hyperthyroid, diabetes, neoplasia, sepsis, drugs/toxins), bacterial fermentation
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2 causes of decrease anion gap.
decrease unmeasured anions= hypoalbuminemia and hemodilution, increased unmeasured cations= hypercalcemia and hypergammaglobulinemia (myeloma)
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Corrected calcium = ?
Ca + (3.5- Albumin)
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Blood gas pH that is decreased indicated.
acidemia
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Blood gas pH that is increased indicated...
alkalemia
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Measure of alveolar ventilation and is used to determine respiratory contribution to acid-base homeostasis.
pCO2
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Decrease pCO2.
respiratory alkalosis
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Increased pCO2.
respiratory acidosis
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Measure of the non-respiratory contribution to acid-base homeostasis.
bicarbonate
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Decreased bicarb (HO3).
metabolic acidosis
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Increased bicarb (HCO3).
metabolic alkalosis
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Metabolic acidosis is indicated by decreased _________ and the expected respiratory compensation is...
plasma HCO3 (bicarb); hyperventilation to exhale CO2
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When loss of bicarb is the cause for metabolic acidosis, there is a(n) _________ anion gap and _______ chloride; 3 causes for this...
normal; increased or high normal; saliva of ruminants, diarrhea, renal tubular acidosis
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When bicarb consumption is the cause for metabolic acidosis, there will be a(n) ______ anion gap and ______ chloride; causes for this include...
high; normal; LUKES-lactic acid, uremic acids, ketones, ethylene glycol, salicylates
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Metabolic alkalosis is indicated by increased ________; its expected respiratory compensation is...
bicarb; hypoventilation to retain CO2
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When metabolic alkalosis is caused by HCL loss or sequestration, differentials include... (7)
vomiting, gastric tube, gastric obstruction, displaced abomasum, torsion, renal disease, GI stasis (hypocalcemia)
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Metabolic acidosis caused by paradoxical aciduria is associated with...
hypovolemia, hypochloridemia, and totally body loss of K+
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With mixed metabolic acidosis and alkalosis, there is _______ HCO3, ______ serum Cl-, and _______ anion gap.
normal to increased; decreased; increased
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2 mechanisms for mixed metabolic acidosis and alkalosis.
gastric torsion (vomiting, decreased intake, HCl sequestered), organic acidosis (diabetic ketoacidosis or renal failure)
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Respiratory acidosis is associated with increased _______, and the expected metabolic compensation is...
pCO2 (hypoventilation); increased resorption of HCO3 (may take days)
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Causes of respiratory acidosis. (5)
moss of neurogenic control (anesthesia, head trauma), failure of breathing mechanics (pneumothorax), marked pulmonary abnormalities (pneumonia, pulmonary edema)
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Respiratory alkalosis is associated with ____________, and the expected metabolic compensation is...
decreased pCO2 (hyperventilation); increased excretion of HCO3 (requires several days)
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Causes of respiratory alkalosis. (5)
altered respiratory control (excessive panting, convulsions, encephalopathy), mechanical ventilation, hypoxemia due to hypotension or pulmonary shunts
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