Calcium deficit

(hypocalcemia)
m. Ntjabane
Calcium:

 Ca2+ is located in skeletal muscles (in bone and teeth)

 Calcium in blood is bond to protein for transportation
 Ca2+ serum concentration is (8.6mg/dl -10.2mg/dl or 2.2mmol/l
-2.6mmol/l
Functions of calcium:
 1. Plays a major role in transmission of impulse in nervous system
 2. Regulates muscle contraction and relaxation including cardiac
muscle
 3. Ca2+ activates enzymes that stimulates energy production (Creb
cycle)
Objectives:

 Define hypocalcemia?
 Identify contributing factors to hypocalcemia?
 Identify clinical manifestation for hypocalcemia?
 Discussthe management of patients with
hypocalcemia?
Hypocalcemia

 It is a condition where serum concentration is below 8.6mg/dl

or 2.15mmol/l

 Causes of Hypocalcemia:
 1. Osteoporosis: Post menopausalk
 2. Prolonged rest
 3. Hypoparathyroidism and surgical hypoparathyroidism
 4. Excessive administration of citrate blood (citrate bind to
Ca2+ remove it from blood
Causes of Hypocalcemia:

 5. Inflammation: pancreatitis causes break down of lipids

and protein. Ca2+ binds to Lipolysis (fatty acids) and form
soap. Hypocalcemia results.
 6. Hypocalcemia is related to excessive secretion of
glucagon. Glucagon is related to increased secretion of
calcitonin.
 7. Hypocalcemia is common in patients with renal failure
(they have increased level of phosphate hyperphosphatemia)
 8. Inadequate Vitamin D consumption
Causes of Hypocalcemia:

 9. Hypocalcemia is related to magnesium deficiency

 10. Medullary thyroid cancer
 11. Low serum albumen
 12. Alkalosis and alcohol abuse
 13. Medication: aluminum anti-acids, aminoglycosides,
caffeine, corticosteroids, phosphates, isoniazid and loop
diuretics
Clinical manifestations

 1. Tetany caused by excessive neural excitability

 Tingling sensation on the finger and mouth
 Spasm of muscles of the legs and face
 Hyperactivity of Deep tendon reflex (DTR)
 NB. Trousseau’s sign: is inflicted by putting a the BP cuff on the
upper arm the carpal spasm occurs ( the thumb is adducted and
the metacarpal and interpharingeal joint extended)
 Chvostek sign: the twitching of the facial muscle anterior to ear
lobe
Clinical manifestations

 2. Seizures: hypocalcemia causes irritability of nervous system

 3. Mental changes: Depression, impaired memory, confusion,
delirium and hallucinations (impaired perception)
 4. Alterations on the ECG: Prolonged QT interval and Prolonged
ST segment (repolarization of the ventricle)
 5. respiratory problems: Dyspnea and laryngospasm
 6. Alteration on integumentary system: Increase bowel
movements, dry and brittle hair, nail and abnormal clotting
Management of hypocalcemia

 Acute state of hypocalcemia is life threatning

 NB. Parenteral replacement of calcium: calcium Gluconate not
Calcium Chloride it irritates the tissues.
 Dextrose 5% in water D5% W and add Calcium gluconate and administer
it slowly and monitor BP
 Provide Vit D therapy
 Provide Ca2+ containing diet: Milk and milk products, alkaline acids,
green and leavy vegetables, canned salmon, sardine and fresh oysters
 Avoid alcohol intake, caffeine and cigarette smoking it increases
excretion of Ca2+ in the kidneys
Hypercalcemia

 It is a condition where serum level is above 10.2mg/dl or

2.6mmol/l
 NB. Hypercalcemia has high mortality > 50%

 Causes of hypercalcemia are:

 Malignancy Parathyroid cancer or hyperparathyroidism
 PTH(parathyroid Hormone) promote Ca2+ release from
bone, reabsorption of Ca2+ from kidneys and intestines
Causes of Hypercalcemia

 Multiple fractures and spinal Injury (mobilization)

 Thiazides diuretic increase Ca2+ reabsorption in the
kidneys
 Peptic ulcer patients: treated with calcium salts
 Vitamin A and D intoxication
Clinical manifestation of hypercalcemia

 1. Muscle weakness, incoordination,

 2. anorexia, nausea, vomiting and constipation
 3. Dehydration
 4. Bone and abdominal pain, abdominal distention and
paralytic ileas
 5. Excessive thirst and polyurea
 NB. Ca2+ increase the effects of Inotropic Drugs (digitalis)
 6. Confusion, impaired memory, slurred speech, lethargy
Medical management of hypercalcemia

 Fluid administration to dilute Ca2+ concentration. E.g.

fluids are sodium chloride 0.9% (sodium enhances
excretion of ca2+)
 Administer furosemide increase Ca2+ excretion
 Administer Calcitonin to increase Ca2+ deposit in the
bones
 Corticosteroids
 Promote intake of fiber diet