Ca++

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Author:
marshenski
ID:
210257
Filename:
Ca++
Updated:
2013-03-29 17:53:05
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BC Boston College CRNA Chem lytes
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BC Boston College CRNA Chem:lytes
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  1. What gland is responsible for homeostasis Ca?
    • parathyroid glad
    • thyroid
  2. Where is the greatest concentration of Ca found?
    in the ECF
  3. What are the different percentages associated with the availability of Ca?
    • Ionized in the plasma 50%
    • protein bound 41%
    • complexed to an anion 9%
  4. Which of the partitions of Ca in the body is the active form?
    Ionized
  5. Acute acidemia will ______ the ionized Ca? (increase/decrease)
    increase
  6. Acute acidemia will ______ the ionized Ca? (increase/decrease)
    decrease
  7. 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
  8. What is hypoCa?
    ionized Ca <4 mEq/Dl or 2 mEq/L
  9. 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
  10. When we give a lot of RBC's what happens with the Ca level?
    decreased due to the action of citrate chelating Ca.
  11. In what cases would the citrate left behind by transfusions precipitate in cardiac abnormalities?
    a pt with renal or liver disease
  12. What are some instances that might decrease Ca levels?
    • massive transfusions
    • hypothermia
    • excess sodium bicarbonate
  13. What patients are especially prone to develop hypoCa?
    • 80% of critically Ill Pt's
    • 25% of non-ICU pt's
  14. 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
  15. How is the differential diagnosis made?
    • Age of the pt
    • The serum phos
    • general clinical status
    • duration of hypoCa
  16. What level if drawn on a pt might indicate VitD deficiency?
    Hypo Ca in lieu of Low phos
  17. In a pt whit chronic low Ca, what is the most likely cause of low CA?
    hypoparathyroidism
  18. How do we normally treat hypoCa?
    • treat underlying cause
    • Correct other lyte abnormalities
  19. What other lyte imbalances will potentate cardiac or neuro changes with hypoCa?
    • hyperK
    • HypoMag
  20. Do we get really concerned with mild hypoCa?
    not really, don't want to overtreat it
  21. What is an acute treatment of hyopCa?
    • CaChloride
    • Cagluconate
  22. Explain the rule of 10's when treating hypo Ca?
    10ml of 10% Cagluconate over 10 minutes. followed by an infusion
  23. Why do we administer Vit D with a hypoCa pt?
    increase the Ca uptake
  24. What is hyper Ca?
    • ionized Ca >3 mEq/L 1.5 mmol/L
    • serum Ca > 10.5 mg/dl
  25. Under what level of total Ca are pt's usually not symptomatic?
    11.5
  26. What is the treatment of hyper Ca?
    treat the underlying cause
  27. What is the acute treatment of Ca?
    Dilute the Ca with NS
  28. Ca above what level is a medical emergency?
    14 mg/dl
  29. 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
  30. 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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