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Calcium, Ionised calcium - Coggle Diagram
Calcium
Ionised calcium
Hypocalcaemia
Unimportant problem clinically unless clinical signs
Secondary to hypoalbuminaemia and pancreatitis
Always investigate underlying cause
Acute IV 10% calcium gluconate
0.5-1ml/kg to effect followed by 6.5-10ml/kg/24hr as CRI
Subacute oral medication
Calcitriol 20-30ng/kg/24hrs tapering to 5-15ng/kg/24hrs
AT-10: 20-30ug/kg/24hrs tapering to 10-15ng/kg/24hrs
Calcium: Phosphate ratio diagnostic
Low phosphate = PTH issue
High phosphate = calcitriol issue
Calcium phosphate product results in irreversible soft tissue calcification (>5.5)
Pathalogical
Increased PTH activity
Primary hyperparathyroidism
Keeshunds (autosomal dominant)
Older dogs >6 years
Increased and autonomous PTH production by functional neoplasm
Increased PTH-like activity
Humoral hypercalcaemia of malignancy
i.e., lymphosarcoma, anal sac adenocarcinoma, multiple myelomas
Or, non-PTH dependent causes of hypercalcaemia
Vitamin D toxicity
Granulomatous inflammation
Hypoadrenocorticism
Chronic kidney disease
will ALWAYS have hyperphosphataemia
In cats
Idiopathic
The most common cause of hypercalcaemia in middle-aged cats
Develop calcium oxalate uroliths
Dietary management
Monitor USG, renal function and calcium
Diagnosis of exclusion
Osteolysis
Management
Correct underlying cause
Reduce degree of hypercalcaemia
Fluid therapy
Frusemide
Bisphosphates
Pamudrinate
Alendronate
Repeatable hypercalcaemia should ALWAYS be investigated
Look at PHOSPHATE and LEVEL OF AZOATEMIA
Non pathological causes
Rapidly growing young dogs, spurious laboratory error
Transient/Interpretative
Haemoconcentration, hyperalbuminaemia
Lipaemia increases ionised calcium
pH elevations increase protein binding and decrease ionised calcium
Clinical signs: PUPD, weakness, lethargy, depression, inappetence, vomiting, diarrhoea, constipation, facial puritus, oral discomfort, muscle twitching and fasciculations, cardiac tachydysrrhythmias and arrest
Interferes with ADH action on collecting tubules, decreasing medullary hypertonicity and vasoconstriction on afferent arterioles = azotaemia