CALCIUM AND IT S DEFICIENCY

CALCIUM A positive charge ion, abundant in skeletal system (99%) and the only one % seen in the plasma.

Normal total serum calcium level 8.6 to 10.2 mg/dL (2.2 to 2.6 mmol/L

Help regulate muscle contraction and relaxation including cardiac muscles.ROLE of the CALCIUM Transmitting nerve impulses. Instrumental in activating enzymes that stimulate many essential chemical reactions in the body Play a role in blood coagulation .

The serum calcium level is controlled by Parathyroid Hormone and Calcitonin.D. . Calcium is excreted primarily in the feces with the remainder excreted un the urine.Sources: Milk Cheese Butter Ice cream REMEMBER!!!! Calcium is absorbed from foods in the body presence of normal gastric acidity and Vit.

ABSTRACT Hypercalcemia: a finding indicative of a prostatic adenocarcinoma Abstract Calcemic alterations in prostate cancer are extremely rare. We present a case of prostate carcinoma diagnosed in a 76-year-old patient. and may at times be a datum prior to the diagnosis of the tumour. which was corrected after treatment by means of complete androgenic blocking.net/publication/20624118_Hypercalcemia_a_finding_indicative_of_a_prostatic_ade nocarcinoma . and even in the absence of this in response to humoral mechanisms. http://www. The existence of hypercalcemia may indicate tumoural recurrence. Hypercalcemia may be seen in cases of multiple osseous dissemination. In cases of disseminated prostate adenocarcinoma hormones treatment may secure the normalization of blood calcium. as a result of the presentation of a hypercalcemic metabolic syndrome.researchgate.

METHODS: After January 1. 2006. eliminating the need for emergency room visits. . can lead to postoperative emergency room visits for laboratory testing and intravenous calcium infusion. the most common complication of total thyroidectomy. 271 consecutive patients underwent total thyroidectomy with postoperative parathyroid hormone testing (group 1). Group 2 consisted of 100 consecutive patients who underwent total thyroidectomy prior to 2006 without parathyroid hormone testing and were treated according to surgeon preference and serum calcium levels. A method to identify patients reliably at risk for postoperative hypocalcemia could allow prophylactic treatment to avoid this. We hypothesized that quick parathyroid hormone testing within 4 hours of thyroidectomy and a protocol to treat parathyroid-hormone-deficient patients would reduce symptomatic hypocalcemia.Postoperative parathyroid hormone testing decreases symptomatic hypocalcemia and associated emergency room visits after total thyroidectomy.25-ug calcitriol twice daily and 2-6 g of calcium carbonate daily for 1 week. Patients with parathyroid hormone levels <10 pg/mL were treated according to a newly instituted protocol with 0. Patients with parathyroid hormone levels 10 pg/mL were treated with calcium only. Abstract ‡ BACKGROUND: Symptomatic hypocalcemia.

8% vs 8.‡ RESULTS: Patients in the 2 groups were similar with regard to age. P = .0%. who had parathyroid hormone testing.005). All rights reserved. Inc. CONCLUSION: Postoperative parathyroid hormone testing reliably identifies patients at risk for hypocalcemia after thyroid surgery. Therefore. Also. sex. patients in group 2 had a higher incidence of malignancy (P = . Furthermore. patients with postoperative serum parathyroid hormone levels <10 pg/mL after thyroid surgery should be treated with calcitriol and calcium to prevent symptomatic hypocalcemia. P = . the number of patients who made visits to the emergency room was less in patients who had parathyroid hormone testing compared with those who did not (1. parathyroid hormone testing and calcitriol administration to patients at risk decreases the incidence of hypocalcemia and associated emergency room visits after total thyroidectomy. However. had greater postoperative calcium levels (P < . patients in group 1.008).com/mesh_browser/Nutritional%20and%20Metabolic%20Dise ases/Metabolic%20Diseases/Calcium%20Metabolism%20Disorders/Hypoc alcemia/pg/1 . Moreover. patients in group 1 had a lesser incidence of symptomatic hypocalcemia (7% vs 17%. | PMID: 20723956 http://pubget. Copyright © 2010 Mosby.04). Importantly.005). and thyroiditis.

However. . It can be due to localized osteolytic hypercalcemia or elaboration of humoral substances such as parathyroid hormone-related protein from tumoral cells.Hypercalcemia and huge splenomegaly presenting in an elderly patient with B-cell nonHodgkin's lymphoma: a case report Abstract Introduction Hypercalcemia is the major electrolyte abnormality in patients with malignant tumors. a third mechanism of uncontrolled synthesis and secretion of 125(OH)2D3 from tumoral cells or neighboring macrophages may contribute to the problem. In hematological malignancies. hypercalcemia is quite unusual in patients with B-cell non-Hodgkin's lymphoma.

She had huge splenomegaly and was hypercalcemic. anorexia. After correction of her hypercalcemia. CD20 and parathyroid hormone-related peptide. High serum calcium is seen in only seven to eight percent of patients with B-cell non-Hodgkin's lymphoma. She was mildly anemic and complained of fatigability.com/content/4/1/330/abstract . Conclusion ‡ Immunopositivity for parathyroid hormone-related peptide clearly demonstrates that hypersecretion of a parathyroid hormone-like substance from the tumor had led to hypercalcemia in this case. It should be noted that presentation with hypercalcemia has a serious impact on prognosis and survival. Her immunohistochemistry was positive for leukocyte common antigen. Evaluation of serum parathyroid hormonerelated protein and 1-25(OH)2D3 can be helpful in diagnosis and management.jmedicalcasereports. apparently due to different mechanisms. she had a splenectomy. Microscopic evaluation revealed a malignant lymphoma. http://www.Case presentation ‡ An 85-year-old Caucasian woman presented with low grade fever. abdominal discomfort and fullness in her left abdomen for the last six months.

Hypocalcemia pathopysiology .

.‡ When extracellular fluid calcium concentration falls below normal. By stimulating bone resorption By stimulating activation of vitamin D. which then increases intestinal reabsorption of calcium. By directly increasing renal tubular calcium reabsorption. the parathyroid glands are directly stimulated by the low calcium levels to promote increased secretion of PTH. ‡ PTH regulates plasma calcium concentration through three main effects.

Ca Vit D3 Activation PTH Intestinal Ca Reabsorption Renal Ca Reabsorption Ca Release From Bones .

. and increased urinary excretion of calcium.‡ Hypocalcemia can also develop from an inadequate intake of vitamin D as a result of intentional changes of diet. decreased GI absorption. ‡ Parathyroid disease decreases plasma calcium level a deficiency of parathyroid hormone results in a decreases in plasma calcium levels because of decreased bone resorption.

promotes the excreation of calcium. because alkalosis causes decreased calcium ionization. with subsequent binding of free fatty acids to calcium.‡ Hypocalcemia can develop in people with pancreatitis owing to release of lipase into soft tissue spaces. . as seen in cushing disease. ‡ Excess sodium. leading to more calcium protein binding. ‡ Over correction of acidosis may lead to hypocalcemia.

and neomycin ‡ Aspirin.‡ Several medications have been linked with hypocalcemia: ‡ magnesium sulphate. anticonvulsant and estrogen ‡ Phosphate preparations ‡ Steroids ‡ Loop diuretics ‡ Antacids and laxatives .colchicines.

‡ Nursing Management in Hypocalcemia Clinical Management Tetany Trousseau s sign Chvostek s sign Seizures Medical Management IV calcium administration Vitamin D therapy .

Strategies to reduce falls.‡ Nursing Management Seizure precautions are initiated when hypocalcemia is severe. Airway is closely monitored because laryngeal stridor can occur. High risk for osteoporosis are instructed about the need for adequate dietary calcium intake. Value of regular weight-bearing exercise in decreasing bone loss should be emphasize. .

5 mEq/L or 11mg/dl It is a common electrolyte disorder that can have serious physical complications ETIOLOGY AND RISK FACTORS: 1. Thiazide diuretic therapy .Hypercalcemia Defined as a plasma Ca level greater than 5. Hyperparathyriodism 3. Metastic malignancy 2.

Gastrin and pancreatic enzyme Excess Ca in the kidney Cell membrane threshold becomes more positive Decrease neuromuscular excitability Disturb cardiac muscle function and electrical conduction through the heart S/Sx: Increase in HR and Bp Retention of Ca by the kidney .Pathophysiology Increase serum Ca Increase resorption of Ca in the bones Destruction of bone tissues Ca is released in ECF Increase Ca absorption in the intestine Release HCL.

Nocturia .polydipsia.Slows bowel transit time Causes osmotic diuresis Constipation Polyuria S/Sx: Decrease motility Hypoactive bowel sound Abdominal Distention Ca precipitates tend to form ureteral or kidney stones Urinary Blockage Neurologic depression Risk for thrombus formation Bradycardia lethargy S/Sx: increase urinary output Increase thirst Impaired Glomerular Blood flow Renal Failure Depressed sensorium Confusion Muscle weakness Decrease deep tendon reflex Cardiac Arrest S/Sx: polyuria.

Dehydration Treatment: Diuretics Calcium chelators Fluid volume therapy Coma Death .

S/Sx: Mild Hypercalcemia: slightly above 5.2 mEq/L or 13mg/dl  Anorexia  Nausea and vomiting  Polyuria  Muscle weakness  Fatigue  Lethargy  Dehydration  Constipation Chronic hypercalcemia: may develop similar symptoms to those of peptic ulcer.5mEq/L or 11mg/dl  Asymptomatic Moderate Hypercalcemia: Ca levels of 6.  Confusion  Impaired memory  Slurred speech .

 Lethargy  Acute psychotic behavoir  Coma  The more severe symptoms tend to appear when the serum Ca level is approx. 16 mg/dl or above Hypercalcemic crisis refers to an acute rise in the serum Ca level to 17mg/dl or higher.  S/Sx:  Severe thirst  Polyuria  Muscle weakness  Intractable nausea  Abdominal cramps  Obstipation or Diarrhea  Peptic ulcer symptoms  Bone pain .

. Nursing Diagnosis ‡ Risk of constipation related to abdominal muscle weakness ‡ Excessive urination related to disturbed renal tubular function. ± Treating the underlying cause of hypercalcemia.  Medical Management Goal: ± Decrease the serum calcium level and reversing the process causing hypercalcemia. Lethargy  Coma  This condition is very dangerous and may result in cardiac arrest. ‡ Impaired physical mobility related to decreased tone in smooth and striated muscle.

‡ Adequate fiber should be provided in the diet to offset the tendency of constipation. ‡ Assess patient for signs and symptoms of digitalis toxicity. .Interventions: ± Administer fluids to dilute serum calcium and promote its excretion by the kidneys. ± Restriction of dietary calcium intake. ‡ Cardiac rate and rhythm should be monitored for any abnormalities. ‡ Nursing Management Interventions: ‡ Encourage patient to ambulate as soon as possible.

Lourilwin David. Jennifer Anne Dela Torre. Wilhelmina Joy BSN3-B .THANK YOU=> Prepared by: Bandiola. Mary Rose Bedua. April Ann Daarol. Rizaber Bataga. Erika Buhat.

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