Calcium

Calcium

Is amineral is imp. To build up your bones ….your heart to beat…
Your blood to clot….your muscle to contract
99% of it in bones and teeth

Body requirements

Women
Age 50 and younger …….1000 mg daily
Age 51 and older ……1200 mg

Men
Age 70 and younger ……1000 mg
Age 70 and older …..1200 mg
9 -18 age ……1300 mg

Calcium in the plasma:

Only 1%
45% in ionized form (the
physiologically active form)

45% bound to proteins (predominantly albumin)

10% complexed with anions (citrate,

sulfate, phosphate)

To estimate the physiologic levels of ionized

calcium in states of hypoalbuminemia:
[Ca+2]Corrected = [Ca+2]Measured + [ 0.8 (4 – Albumin) ]

Hypercalcemia

Increased GI Absorption:
Vitamin D excess
Elevated PTH

Decreased Urinary Excretion:
Thiazide diuretics
Increased Loss From Bone:
Elevated PTH
Hyperparathyroidism
Malignancy

Note: more then 90% of inpatients hypercalacemia are due to

1.malignancy
2.hyperparathyroidism

Clinical features

Renal : excessive thirst and frequent urination
…renal stones

GIT :upset ,nausea ,,vomiting..constipation

Skeletal :bone pain and weak

muscle…..osteoporosis and osteomalacia

Brain :lethargy ,fatigue ,confusion…depression

Heart :palpitation and arrythmia

Complication:
Metastatic calcification
Renal stones
Osteoporosis
Dementia and coma
arrythmia

Treatment of hypercalcaemia:

Saline/fluid hydration :
--increases renal calcium excretion
---2 to 4 L IV daily for 1 to 3 days
Biphosphonates :
---inhibition bone resorption
---Pamidronate (Aredia), 60 to 90 mg IV over 4 hours
Calcitonin :
----inhibition bone resorption and increases renal calcium excretion
----4 to 8 IU per kg IM or SQ every 6 hours for 24 hours

Pli-camycin (Mitharmycin) :

----decreases bone resorption
----25 mcg per kg per day IV over 6 hours for 3 to 8 doses
Gallium nitrate :
-----inhibition bone resorption
-----100 to 200 mg per m2 IV over 24 hours for 5 days
Glucocorticoids :
----Inhibits vitamin D conversionto calcitriol
-----Hydrocortisone, 200 mg IV daily for 3 days
Hemodialysis :
---used in patients with renal failure

Hypocalcaemia

Is a condition in which the calcium level below less then 8.8 mg/dl (less 2.2 mmol/l) in the presence of normal plasma protein conc.

Etiology of the hypocalcemia
Decreased GI Absorption
Hypoalbuminemia
Hyperphosphateamia
hypomagnacemia
Poor dietary intake of calcium,impair absorption
Increased Urinary Excretion
Decreased Bone Resorption/Increased Mineralization

Low PTH …..neck iiradiation ,,postsurgery….autoimmune….infiltarative ,,,,hereditary

PTH resistanc
Pseudohypoparathyrodism
…….
Acute pancreatitis

Hungry bone syndrome

Vitamin D deficiency

Clinical features

Numbness and tingling sensation in……
Muscle cramps
Tetany….carpopedal spasm
Wheezing …dysphagia…laryngiospasm
Neuropsychiatric symptoms
Seizures
Acute hupocalaemia may lead to syncope and heart failure
Chronic one may cause cataract itching dry skin

• Signs ….important

• Trousseau sign…..How????
• Chvostic sign ….How ????
•

•

Treatment

If mild symptoms just oral calcium ….1-3 g|day
If sever symptoms ….I.V infusion
Doses of 100 -300 mg of elemental calcium (10 ml of calcium gluconate contain 90 elemental calcium….10 ml of calcium chloride contain 272 mg of elemental one…)in 50 -100 ml of 5%dextrose within 10 min.
CHRONIC
Depend on the cause
With oral cacium….if sever hypoparathyroidism give vit. D3






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