Disorders related to altered calcium levels in the blood

Calcium is essential for: the formation of bones and teeth, muscle contraction, blood clotting, and to have a normal heart rhythm.

The body precisely controls the amount of calcium present in cells and in the blood. To do this, it moves from the bones to the blood, as necessary, in order to maintain a constant concentration in the blood of this mineral. To maintain an adequate concentration of calcium in the blood, a minimum of between 1,000 and 1,500 mg of calcium per day.

This concentration is regulated for the most part by two hormones:

• Parathyroid hormone (PTH): It is produced by the four parathyroid glands located around the thyroid gland in the neck. When the concentration of calcium in the blood decreases, the parathyroid glands produce more parathyroid hormone. If the concentration of calcium increases, the parathyroid glands produce less hormone.
• Calcitonin: it is produced by cells of the thyroid gland; reduces the concentration of calcium in the blood, slowing its release from the bones.

Hypocalcemia, low calcium

It occurs when the concentration of calcium in the blood it is low. It is defined by the decrease in lower blood calcium at 8.8 mg / dL.

Although most of the body's calcium is stored in the bones, another part circulates in the blood. About 40% of the calcium in the blood is bound to proteins, acts as a reserve source of calcium for cells and has no function in the body. Only calcium that is not bound to proteins can alter the functioning of the body.

Causes

In most cases, hypocalcemia occurs when too much calcium is lost in the urine or when not enough calcium moves into the blood from the bones.

Causes of hypocalcemia include:

• A low concentration of parathyroid hormone (hypoparathyroidism) or absence of parathyroid glands at birth (in DiGeorge syndrome).
• A low concentration de reduces the activity of parathyroid hormone.
• Lack or resistance of.
• Renal insufficiency, which results in a greater amount of calcium being excreted in the urine.
• Inadequate calcium intake or disorders that reduce calcium absorption.
• Pancreatitis (inflammation of the pancreas)
• Certain medications such as rifampin (an antibiotic), anticonvulsants, bisphosphonates, calcitonin, chloroquine, corticosteroids, etc.

Consequences

If calcium levels are low for a long time, the skin becomes dry and flaky, the nails break, the hair is thicker, and you feel muscle cramps and fatigue. Hypocalcemia affects the brain and causes symptoms such as confusion, forgetfulness, delirium, depression, anxiety, and hallucinations. These symptoms disappear when the calcium concentration is restored.

Symptoms

One of the main symptoms of severe acute hypocalcemia is tetany, characterized by muscle stiffness and cramps. The symptoms of tetany can range from tingling of the lips, hands or feet and cramps, to seizures, cramps in the throat muscles, arrhythmias, etc.

Diagnosis and treatment

The diagnosis is through a routine blood test. The total calcium concentration, the concentration of albumin in the blood to determine if the level of free calcium is low, as well as the levels of magnesium, phosphate, parathyroid hormone and vitamin D.

Treatment of hypocalcemia consists of administering calcium and vitamin D supplements.

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Hypercalcemia

It is a relatively frequent clinical problem. It results when the entry of calcium into the circulation exceeds the excretion of calcium.

This occurs in various situations, for example, when there is a alteration in the bones or when it exists excessive gastrointestinal absorption or a decreased renal excretion of calcium.

Among all causes of hypercalcemia, primary and malignancy are the most common, accounting for 90% of cases.

Causes

• At hyperparathyroidism too much parathyroid hormone is secreted. When there is an excess of hormone, the absorption of calcium from the digestive tract is stimulated and causes the kidneys to excrete less calcium and at the same time, the bones to release stored calcium, causing hypercalcemia. In 90% of cases, the abnormality is the presence of a benign tumor (adenoma) in one of the parathyroid glands. In the remaining 10%, the glands simply hypertrophy and produce too much hormone. The usual treatment consists of surgical removal.
• Presence of a stomach ulcer.
• Increased intake of vitamin D, which causes an increase in the absorption of calcium in the digestive tract.
• Cells from kidney, lung, and ovarian tumors secrete large amounts of a protein that, like parathyroid hormone, increases the concentration of calcium in the blood. This is calledparaneoplastic syndrome. Calcium is also released into the blood when cancer spreads (metastasizes) to bone and destroys bone cells. This bone destruction occurs most often in prostate, breast, and lung cancers. Themultiple myeloma (a cancer of the bone marrow) also destroys the bone and causes hypercalcemia.
• Bone disorderssuch as where bone destruction occurs (bone resorption or resorption), calcium is released into the blood, sometimes causing hypercalcemia.

Symptoms

Hypercalcemia usually produces few symptoms. The first symptoms of hypercalcemia are usually:

• Constipation,
• Sickness,
• Vomiting
• Abdominal pain,
• Lack of appetite
• Increased urination, leading to dehydration and excessive thirst.

When hypercalcemia is very severe, brain dysfunction appears accompanied by confusion, mental disturbance, delirium, hallucinations and coma, muscle weakness, along with arrhythmias and death.

Diagnosis and treatment

Hypercalcemia is usually detected by performing routine blood tests. Additional tests may be needed to determine the cause, such as additional blood and urine tests or a chest X-ray.

Hypercalcemia can be classified according to blood levels in:

• Mild: 10.5 to 11.9 mg / dL
• Moderate: 12 to 13.9 mg / dL
• Severe: 14-16 mg / dL

Treatment consists of administration of fluids and medications to increase the excretion of calcium. Drinking plenty of fluids is advised, as this stimulates the kidneys to remove calcium and helps prevent dehydration.

• The body precisely controls the amount of calcium present in cells and in the blood. It does this by moving calcium from the bones into the blood, as needed, in order to maintain a constant blood concentration of this mineral.
• Hypocalcemia occurs when the concentration of calcium in the blood is low. It is defined by a decrease in blood calcium below 8.8 mg / dL.
• Hypercalcemia is a relatively common clinical problem. It results when the entry of calcium into the circulation exceeds the excretion of calcium.