CALCIUM (Ca++)

CONDITIONS CAUSING
NORMAL/PANIC VALUE HYPERCALCEMIA CONDITIONS CAUSING HYPERCALCEMIA HYPOCALCEMIA
HYPOCALCEMIA
Normal adult: Cardiovascular Increased calcium absorption: Cardiovascular Interference with absorption of
8.2-10.2mg/dl  !st, 2nd, 3rd degree and bundle  Excess calcium ingestion  Arrhythmias calcium from GI tract:
2.05-2.55mmol/liter branch block  Excessive intake of milk and antacids  BradycardiaV-TachAsystole  Chronic renal failure
 Bounding peripheral pulses  Vitamin D toxicity
Normal urine in  Changes in EKG (prolonged ST segment  Malabsorption (celiac disease,
 Bradycardia Decreased calcium excretion:
adult: and Q-T interval) tropical sprue, pancreatic
 Cardiac arrest  Adrenal insufficiency
100-300mg/24 hrs
 Changes in EKG (shortened  Renal disease  Diminished peripheral pulses insufficiency)
2.5-7.5mmol/24 hrs QT segment, wide T wave)  Use of Thiazide diuretics  Hypotension  Renal tubular disease
 Hypertension Increased bone resorption of calcium:  Prolonged bleeding time  Vitamin D deficiency (rickets)
Panic values: Neuromuscular  Hyperparathyroidism  Reduced cardiac output Decreased ionized fraction of
below 7mg/dl Apathy  Primary Hyperthyroidism Neuromuscular excitability calcium:
above 12mg/dl Depressed or absent DTRs  Prolonged immobilization  Muscle twitching (+ Trousseau's sign)  Alkalosis
(hyporeflexia)  Thyrotoxicosis  Facial spasms (+ Chvostek's sign)  Acute pancreatitis
Calcium in Foods: Disorientation  Use of glucocorticoids  Hyperphosphatemia secondary to
 Carpopedal spasm
NATURAL FOODS: Drowsiness Malignancy that causes bone destruction and
Headache
 Circumoral paresthesia renal failure
 dried legumes release of calcium or PTH into the bloodstream:
 vegetables Irritability  Breast. colon and ovarian cancer that  Convulsions Drug induced:
 Hyperactive DTRs  Alcohol
 salmon Lethargy metastasizes to the bone
 Anticonvulsants (inhibit GI CA
 tofu Muscular weakness  Cancer (bone, Burkitt's lymphoma. Hodgkin's  Laryngospasm
absorption)
 rhubarb Ultimately, stupor and coma lymphoma, leukemia, myeloma, parathyroid  Muscle cramps  Citrate buffered blood/products used
 sardines GI and metastases from other organs)  Numbness in the extremities for transfusions
 collard greens  Anorexia  Lung disease (TB, histoplasmosis,  Tetany  Loop diuretics
 spinach  Constipation coccidioidomycosis, berylliosis)
 Tingling  Magnesium lowering drugs
 turnip greens  Hypoactive bowel sounds  Lymphoma
 Hx Pathological Fractures  Phosphates
 okra  Nausea  Malignant disease without bone involvement
GI Surgical removal of parathyroid:
 white beans  Polydipsia (squamous cell carcinoma of the lung, kidney

 baked beans  Vomiting cancer)  Abdominal cramping Accidental
 Hypoparathyroidism
 broccoli Renal  Multiple myeloma  Diarrhea
 Radical neck dissection causes
 peas  Azotemia Hemoconcentration of calcium:  Hyperactive bowel sounds
ischemia to parathyroid tissue
 Brussels sprouts  Polyuria  Addison's disease (adrenal insufficiency)
 Total parathyroidectomy
 sesame seeds  Renal calculi formation  Dehydration
 Use of Lithium
Others:
 almonds (kidney stones)
 Cushing's syndrome
CALCIUM-FORTIFIED Behavior Other:
 Acidosis  Cystinosis
FOODS:  Acute psychosis
 Acromegaly  Fat embolism
 milk  Apathy
 Idiopathic hypercalcemia of infancy  Hepatic cirrhosis
 soy milk  Bizarre behavior
 Multiple bone fractures  Hypoalbuminemia
 cheese  Depression
 Paget's disease  Hypomagnesemia
 yogurt  Inability to concentrate
 Inadequate nutrition
 Recent memory impairment  Pheochromocytoma  Leprosy
 Polycythemia vera
 Renal transplant  Neonatal prematurity
 Rhabdomyolysis  Osteomalacia (advanced)
 Peritonitis
 Sarcoidosis
 The most prevalent electrolyte in the body
 regulated by the parathyroid glands and the action of Vitamin D
 99% of the body's calcium is stored in the teeth and bones
 circulating calcium is approximately 50% freely ionized and 50% bound to the protein, albumin
 serum (↓)protein is low, the serum (↓)calcium will be low as well
 (↑)calcium and (↑)parathyroid hormone levels are proportional
 (↓)calcium and (↑)phosphorus levels are inversely proportional

 the calcium circulating in the blood is involved in:

o blood clotting
o transmission of nerve impulses
o neuromuscular conduction (slows impulses)
o cardiac pacemaker automaticity
o hormone secretion
o control of skeletal and cardiac muscle contraction and relaxation
o should be interpreted with results of other tests and not by itself