Electrolyte Imbalance Condition: Hypo/Hypercalcemia Normal Levels:

System: Electrolyte Imbalance Condition: Hypo/Hypercalcemia Normal Levels: 8.6 to 10.3 mg/dL
Basic Concept

  • Calcium is an important electrolyte in the body.
  • The storage of the calcium takes place in the bones
  • Amount of calcium in the blood is tightly regulated
  • The level of calcium is controlled by Calcitonin and parathyroid hormone.
  • Calcium ions play an important role in regulation muscle contraction, enzyme activity, and blood coagulation.
Pathophysiology

  • Calcium ions are critical to the signaling when controlling a variety of cellular processes.
  • Calcium exists as a free cation, in bound state, and complexed with other ions.
  • Calcium signaling pathway indicates the role of the mineral in regulating the enzymes and proteins.
  • Calcium function as a signal transducer through the activation of ion channels.
Risk Factors

Hpyo < 8.8 mg/dL

  • Vitamin D deficiency
  • Magnesium deficiency
  • Chronic and acute renal failure
  • Parathyroid problems
  • Certain medications
Hyper > 10.5 mg/dL

  • Hyperparathyroidism
  • Some of forms of cancers including cancer of the lung and breast
  • Hereditary factors \
  • Severe dehydration
  • Vitamin D over-supplementation
Etiology

Hypo < 8.8 mg/dL

  • Hypoalbuminemia
  • Hyperphosphatemia
  • Medication effects
  • Vitamin D deficiency
Hyper > 10.5 mg/dL

  • Overactive parathyroid glands
  • 20-30% cancer patients develop hypercalcemia.
  • Elevated levels of Vitamin D.
Pathophysiology (Different Types)

  • Hypocalcemia develops when the ECF falls below the recommended range
  • Hypercalcemia develops when there is a surge or rather an increase in the ECF calcium levels.
  • Changes in the calcium levels in the body results in an change in the total calcium in the extracellular matrix.

 

Clinical Presentation

Hypercalcemia

  • CNS effects such as coma, confusion, lethargy
  • Renal effects such as polyuria, kidney stones, and renal failure
  • Gastrointestinal effects; constipation, anorexia, pancreatitis.

Hypocalcemia

  • Neuromuscular symptoms; dysphagia, muscle cramps, numbness
  • Neurologic symptoms; irritability, fatigue, seizures
  • Dermatologic manifestation; coarse hair, brittle nails, cataracts, poor dentition.
Diagnostic Tests

  • Hyperglycemia: Diagnosed using blood tests
  • Hypoglycemia: Basic Blood Tests/Metabolic Panel
Treatment

Hypo

  • Vitamin D supplementation
  • Magnesium and Calcium supplementation
  • Change in the diet
Hyper

  • Reduction in dietary intake of calcium and Vitamin D
  • Giving the patient Bisphosphonates
  • Treating using denosumab (Xgeva)
Complications

Hypercalcemia

  • Osteoporosis
  • Kidney Stones
  • Kidney failure
  • Nervous system problems
  • Arrhythmia
Hypocalcemia

  • Fractures
  • Disability
  • Chronic Muscle Pain
  • Dental Problems
  • Seizures

References

Capriotti, T., & Frizzell, J. P. (2016). Human pathophysiology: Introductory concepts and clinical perspectives.