SAJJAD AHMAD

Introduction
Most abundant mineral in the body

Total content in adult man is 1.0-1.5 kg

About 99% of Ca+2 1%

bone. in blood and ECF

Ca+2 in blood is distributed among three forms. a. About 45% free Ca+2 ions (free/ionized Ca+2) b. 40% is bound to protein, albumin c. 15% is bound to anions (HCO3-, citrate, PO4- &

lactate)

Functions
Calcium is essential for Development of bone and teeth Muscle contraction Nerve impulse transmission Blood coagulation Membrane integrity and permeability Activation of enzymes such as Lipase, ATPase etc

 Release of hormones such as insulin, PTH and

Calcitonin Secretory process such as endocytosis, exocytosis and cell motility Action on heart: Prolong systole Calcium also prevents muscle or leg cramps

Sources of Calcium

Best source:

Milk and milk products

Good source:

Beans, Cabbage, Leafy

vegetables, Fish, Egg yolk

Dietary requirements

Adults

In pregnancy and Lactation

Children Infants

800mg/day 1.5 g/day 0.8-1.2 g/day 300-500 mg/day

Regulation
Three hormones are involved in regulating the level of

Calcium in plasma Parathormone (PTH) b. Calcitonin and c. Vitamin D

a.

Parathormone (PTH)

PTH secretion in blood is stimulated by a decrease in

ionized Ca+2 and, conversely, PTH secretion is stopped by an increase in ionized Ca+2.

 PTH exerts three major effects on both kidney and

bone. 1. In the bone, PTH activates bone resorption, (activated osteoclasts breakdown bone & release Ca+2 in ECF) 2. PTH conserves Ca+2 by increasing tubular reabsorption of Ca+2 3. PTH also stimulates renal production of Active Vitamin D

Vitamin D
Vit D3, diet or exposure of skin to sunlight.
Vit D3 is then converted in the liver in an inactive form. In the kidney, inactive form is hydroxylated into the

active form.
Active form of vitamin D increases Ca+2 absorption in

the intestine and enhances the effect of PTH on bone resorption.

Vitamin D synthesis
Skin
Sun light

Liver

Kidney

25 Hydroxylase

Vitamin D3

25(OH)Vitamin D (inactive)

1,25(OH2)Vitamin D (active)

Tissue-specific Vitamin D Responses

Calcitonin
Calcitonin is antagonist to PTH & vit D Calcitonins Ca+2 lowering effect, inhibits the action

of both PTH and vitamin D

Calcitonin is secreted in response to a hypercalcemic

stimulus.

Calcium Regulation

How much CALCIUM important is!

HYPOCALCEMIA HYPERCALCEMIA

Causes of Hypocalcemia
Primary hypoparathyroidisim (glandular aplasia,

destruction or removal)

Hypoalbuminemia (Chronic liver disease, nephrotic

syndrome, malnutrition)

Acute pancreatitis Vitamin D deficiency Renal disease Pseudohypoparathyroidisim

Symptoms of Hypocalcemia
Neuromuscular irritability
parasethesia, muscle cramps & tetany

Cardiac irregularities arrhythmias or heart block

In severe hypocalcemia, total Ca+2 levels are below

1.88 mmol/L (7.5md/dL)

Metabolic bone diseases

A variety of disease states can affect skeletal architecture, strength and integrity such as
Rickets
Renal rickets

Osteomalacia
Osteoporosis

Rickets

Osteoporosis

Causes of Hypercalcemia
Primary hyperparathyroidism (adenoma or

glandular hyperplasia) Hyperthyroidism Benign familial hypocalciuria Malignancy Multiple myeloma Increased vitamin D Thiazide diuretics Prolonged immobilization

Symptoms of hypercalcemia
Neurologic

symptoms (drowsiness, weakness, depression, lethargy , comma) GI symptoms (constipation, nausea, vomiting, anorexia, peptic ulcer disease) Renal symptoms (nephrolithiasis ,nephrocalcinosis) Hypercalcemia digitalis toxicity

Lab Diagnosis
SPECIMEN COLLECTION
For total Ca, either serum or lithium heparin plasma

collected without venous stasis.

Anticoagulants such as EDTA or oxalate are

unacceptable for use because..

Methodology
CPC, Colorimetric assay with end point determination at 575 nm. Principle;
Calcium

O-cresolphthalein complexone

alkaline solution

Calcium -O-cresolphthalein complex (purple colored complex)

Reference ranges
Total Calcium Serum, Plasma

Child, <12 years 8.8-10.8 mg/dL Adult 8.6-10.0 mg/dL Ionized calcium Serum Child 4.8-5.5 mg/dL Adults 4.6-5.3 mg/dL Ionized calcium Plasma Adults 4.1-4.9 mg/dL

Panic values

It is the policy of AKUH that all critical results should be

communicated as soon as possible but no later than 30 minutes after result verification.
Panic value for Total Calcium is 6.0 12.5 mg/dL