Clinical Signs Of Hypocalcemia Research Articles

Etiology, prevalence and evidence-based therapy and prevention of periparturient hypocalcemia

Periparturient hypocalcemia is a frequently observed metabolic disorder in fresh cows. While the clinical form affects approximately 7 % of German dairy cows, nearly half of the multiparous cows exhibit subclinical hypocalcemia. Although both diagnosis and therapy have not changed over the last three decades, some farmers and practitioners are still unaware about the prevalence of and risk period for subclinical hypocalcemia. Moreover, various recommendations exist concerning the amount of calcium that is to be administered intravenously to a cow experiencing clinical signs of hypocalcemia. This article reviews the causes and prevalence of periparturient hypocalcemia. The aim is further to summarize the results of studies investigating therapy of clinical hypocalcemia in order to provide an evidence-based recommendation on the treatment of recumbent cows. Despite the high prevalence of hypocalcemia, it has been shown that the majority of German farmers do not implement preventive strategies against hypocalcemia. Therefore, we furthermore describe preventive strategies that may be useful in reducing the risk of hypocalcemia, based on what is known from the current literature.

The effectiveness of personalized kinesitherapy on an inclined plane at degree I scoliosis in children: X-ray monitoring

The purpose is to evaluate the effectiveness of complex treatment of grade I scoliosis in children on an inclined plane. Material and methods. Throughout 2021, 42 children with degree I scoliosis aged from 8 to 13 years old (average age 10.5 years) were under observation. All patients with degree I scoliotic disease were prescribed complex treatment, which included personalized kinesitherapy on an inclined plane (Evminov's board), massage, electrical stimulation of the back muscles, and cholecalciferol intake (if indicated). Two groups of patients were identified: Group I – children with grade I scoliosis before treatment (42 persons) and Group II – children with grade I scoliosis in the process of treatment (37 persons). Re-examination was carried out 4-5 months after the start of the course. Results. 45.2 % of children in Group I had complaints of cerebroasthenic nature, which remained in only 12 % of patients in Group II. No clinical signs of hypocalcemia were revealed in the examined children during the initial and repeated laboratory examination. When analyzing the indicators of ultrasound densitometry, 14.3 % of children in Group I had initial signs of osteopenia (Z-Score); 25-hydroxycalciferol was at the lower limit of the normative values in children before the start of treatment. Regression of scoliosis was noted in 80.9 % of children of Group II, according to X-ray data, in 3 patients of this group there was a stable clinical and instrumental picture. Conclusions. The application of an inclined plane for children in the treatment of degree I scoliosis gives a positive result – regression of the spinal deformity. The results indicate the need to develop medical and social programs for the prevention and treatment of degree I scoliotic deformity of the spine in children in general educational institutions at physical education lessons. Key words: children, degree 1 scoliosis, inclined plane, kinesitherapy, radiography, densitometry.

Clinical and pathological analysis of 19 cases of medullary thyroid carcinoma without an increase in calcitonin

BackgroundMedullary thyroid carcinoma (MTC), defined as a malignant tumour with C-cell differentiation, is of neuroendocrine origin and is characterized by the synthesis and secretion of calcitonin (CT). MTC without CT secretion has been reported on rare occasions. The purpose of this study was to evaluate the histological, immunohistochemical, and molecular pathologic features as well as the clinical significance of non-secretory MTC (NCR-MTC). MethodsA retrospective analysis of patients with NCR-MTC was performed. The clinical features of NCR-MTC, including age, gender, tumour size and number, clinical signs of hypocalcaemia and diarrhoea, and the presence of lymph node metastasis, as well as the pathologic features of the disease, including tumour morphology, presence of neuroendocrine structures, capsular invasion, and immunohistochemical expression and presence of mutations in the RET gene, were evaluated. ResultsNineteen patients with NCR-MTC were identified among 158 patients with MTC, resulting in a prevalence rate of 12.02%. Patients with NCR-MTC typically had masses less than 1cm in size (73.7%, 14/19). Hypocalcaemia was not present in 94.7% (18/19) of patients. While 42.1% (8/19) of patients with NCR-MTC did not have amyloid deposits, only 18% (25/139) of patients with secretory MTC did not have such deposits. While 95.7% (133/139) of the control group of patients with secretory MTC had neuroendocrine tumour structure, only 84.2% (16/19) of the patients with NCR-MTC had this type of tumour structure. Patients with NCR-MTC were also less likely to have vascular tumour thrombus, lymph node metastasis or thyroid capsular invasion. With regard to immunohistochemistry, CT expression was mostly negative, and carcinoembryonic antigen (CEA) expression was positive in 21.1% (4/19) of patients with NCR-MTC, while only 5.8% (8/139) of patients in the control group had positive CEA expression. ConclusionsThe prevalence of NCR-MTC was low (12.02%). This type of tumour was smaller in size and more differentiated. Compared with the control group, relatively few patients had obvious symptoms, hypocalcaemia, lymph node metastasis, thyroid capsular or vascular invasion, or tumours with amyloid or neuroendocrine tumour structure.

Changes in electrocardiographic, hematologic and biochemical indices of Markhoz goat breed in experimental hypocalcemia

Background: Milk fever in cattle, sheep and goats occurs around the time of parturition and is caused by hypocalcemia. OBJECTIVES: The aim of this study was to investigate the physiological effects of experimental hypocalcemia on electrocardiography, hematology and serum biochemical changes in Markhoz goat breed. METHODS: Ethylene diamine tetra- acetate solution 4.6% was intravenously infused to 5 healthy goats (experimental group) and 5 healthy goats received 0.9% saline solution (IV) as control group. In both groups, electrocardiogram was recorded in base apex lead and serum was collected before and after infusion. Electrocardiography, biochemical and hematologic parameters were measured. Clinical signs of hypocalcaemia were caused by EDTA infusion. RESULTS: The results in experimental group showed a significant decrease in calcium, lactate dehydrogenase, potassium, and increase in glucose concentration, (p 0.05), heart rate change, presence of arrhythmias and its type were significant (p 0.05). No significant change was seen in control group. CONCLUSIONS: The results indicate that evaluating some biochemical, enzymatic, hematological and electrocardiography changes can be helpful in the diagnosis of hypocalcemia.

Peculiarity of Postoperative Period in Hemodialysis Patients after Parathyroidectomy

Signs of hypocalcemia of varying degrees of intensity are often shown in hemodialysis patients after parathyroidectomy for severe hyperparathyroidism on the background of the “hungry bone” syndrome. Teaching of patients to distinguish early clinical signs of hypocalcemia and to inform the medical staff about them in time and regular monitoring of ionized calcium with a personalized approach to introduction of calcium preparations in parenteral and oral form promote the favorable course of the postoperative period and help to avoid severe complications. Significant reduction of bone pain syndrome and improvement of general health in dialysis patients are noted in the early postoperative period.

A diabetic patient treated for hypertension develops tremors and twitches

Objective: To report an unusual but known cause of hypomagnesaemia-induced hypocalcaemia and review the relevant literature. Methods: We present the clinical and laboratory findings in a case of hypomagnesaemia induced-hypocalcaemia, and discuss the underlying mechanisms in light of the available literature. Results: After admission our patient described typical features of magnesium deficiency such as weakness, tremors and muscle twitches. He also had clinical signs of hypocalcaemia such as a pronounced carpal pedal spasm. Blood results revealed that he had low calcium and magnesium. This was further confirmed by another set of blood results. His vitamin D levels were normal at 25.2 pg/mL and 27.3 pg/mL. His parathyroid hormone was at 18.5 pg/mL (12–72). His urea and electrolytes were normal with sodium of 137 mmol/l, potassium of 3.8 mmol/l, creatinine of 93 mL/minute, and liver function tests in the normal range. Hypomagnesaemia is a common finding and has been reported to be present in nearly 12% of hospitalised patients. From a review of published reports, it is seen that most cases of hypomagnesaemia are due to gastrointestinal or renal losses, but it is also seen with excess alcohol consumption. Drugs such as proton pump inhibitors and, although not often reported, thiazide diuretics are known to cause hypomagnesaemia. The patient was on Indapamide for his hypertension. With replacement therapy, both his ion levels returned back to normal. Conclusion: Hypomagnesaemia is often usually associated with multiple biochemical abnormalities. The increasing use of diuretics and the introduction of potent preparations present a considerable risk for hypomagnesaemia induced-hypocalcaemia.

A Patient on Long-Term Proton Pump Inhibitors Develops Sudden Seizures and Encephalopathy: An Unusual Presentation of Hypomagnesaemia

Objective. To present an unusual but known cause of hypomagnesaemia induced-hypocalcaemia in a chronic GORD patient with severe symptoms with a review of the current literature. Methods. Analysis of the clinical and laboratory findings of the patient and discussion of the multi-factorial nature of his disease and the underlying mechanisms. Results. Our patient described features of magnesium deficiency such as weakness, muscle twitches, and fits with clinical signs of hypocalcaemia: a carpal pedal spasm and paraesthesia. Preadmission blood results revealed low calcium and magnesium levels. He was admitted to ITU, when he presented with seizures and developed encephalopathy. The total vitamin D level was 52.4 nmol/L (>49.9). His U&Es and LFTs were within the normal range with the exception of potassium. He was on Omeprazole for his GORD. With omission of the PPI 1 day after admission and replacement therapy, his ion levels normalised. Conclusion. Hypomagnesaemia is often undiagnosed and is associated with multiple biochemical abnormalities. Treatment focus should be aimed at stopping the PPI and replacing the magnesium. Over use of PPIs is a problem in practice, with the FDA issuing a warning over long-term use. Continued monitoring and decision making on dose reduction/withdrawal is essential to avoid complications.

Intravenous bisphosphonate treatment and pregnancy: its effects on mother and infant bone health

Type 1 Gaucher's disease (GD1) is a lysosomal storage disorder associated with disabling bone involvement. The choice treatment for Gaucher's disease is enzyme replacement therapy (ERT). The use of bisphosphonate treatment for osteopenia and osteoporosis has been suggested. A 22-year-old woman diagnosed with GD1 had received ERT intermittently, depending on availability of the enzyme since the enzyme was not always available. Due to severe bone involvement and multiple vertebral fractures, intravenous administration of 60 mg of pamidronate every 3 months and safe contraception were indicated. Fifteen days after receiving the fourth infusion, the patient informed us she was pregnant. A baby girl was born by cesarean delivery at week 37, showing no evidence of skeletal abnormality or clinical signs of hypocalcemia. The baby developed normally, presenting no significant pathology. At present (age 15 months), height, body weight, and bone mineral density by DXA are within normal range. The mother showed stable total skeleton and right femoral neck bone mineral density (BMD) values, no new fractures, and only ~3% decrease in lumbar spine BMD 15 months post-delivery and after a 1 year breastfeeding period (expected average ~7-8%). It could be posited that pamidronate exerted a positive protective effect on the mother's skeleton with no evidence of adverse effects on pregnancy or on the baby's health to date.

Prevalence of subclinical hypocalcemia in dairy herds

The prevalence of subclinical hypocalcemia in the transition cow is unknown. Cows with subclinical hypocalcemia have no clinical signs of hypocalcemia but may be more susceptible to other diseases. The objective of this study was to determine the prevalence of subclinical hypocalcemia in the US dairy herds. As a part of the United States Department of Agriculture's National Animal Health Monitoring System 2002 Dairy study, serum samples were collected from 1462 cows within 48 h of parturition. The samples were sorted by lactation number: 1st (n=454), 2nd (n=447), 3rd (n=291), 4th (n=166), 5th (n=72), and 6th (n=32). Subclinical hypocalcemia (<2.0 mM) increased with age and was present in 25%, 41%, 49%, 51%, 54%, and 42% of 1st-6th lactation cows, respectively. Cows with serum calcium concentrations >2.0 mM had significantly lower serum non-esterified fatty acids indicating better energy balance than those with subclinical hypocalcemia. Subclinical hypocalcemia may make cows more susceptible to secondary diseases but more research will be required to determine if this is true.

Incidencia de hipocalcemia pos tiroidectomía total

Postoperative hypocalcemia is one of the most common complications of thyroid surgery. It is related to the type of disease (malignant or benign), the number of identified parathyroid glands during the surgical procedure, and the surgeon's experience. Total thyroidectomy is the procedure of choice in our hospital for benign and malignant thyroid disease, but it can increase the incidence of complications. To evaluate the incidence of postoperative hypocalcemia in patients subjected to a total thyroidectomy. Two studies were performed. A retrospective review of medical records of 448 patients subjected to total thyroidectomy, looking for serum calcium levels of less than 8 mg/dl and clinical signs of hypocalcemia. In a second study, 45 patients were followed with measurements of preoperative and postoperative serum calcium levels. In the retrospective study, only 136 records had reliable information. Clinical signs of hypocalcemia were registered in 14% of patients and a low serum calcium level was detected in 50%. In the prospective study, 42% of patients had a postoperative low serum calcium level and seven patients (15%) had symptoms. Patients were handled with oral calcium and calcitriol in some cases. Ninety nine percent of patients had normal serum calcium levels two moths after surgery. In this series, the rate of postoperative hypocalcemia after total thyroidectomy is similar to international reports.

The effect of subclinical hypocalcaemia induced by Na2EDTA on the feed intake and chewing activity of dairy cows.

The effects of induced subclinical hypocalcaemia (SCHC) on feed intake and chewing activity during eating and rumination were studied in dairy cows. Two non-lactating and non-pregnant cows were subjected to three different treatments, with one test per day, such that the plasma free (ionized) calcium (FCa) concentration was maintained at the eucalcaemic level or at one of two constant SCHC levels. The cows and test days followed a 2 x 3 crossover design. SCHC was maintained for 7 h by repeatedly infusing 5% Na2EDTA so that constant FCa concentrations of 0.8 mmol/L or 0.6 mmol/L in plasma were achieved. Control conditions were achieved by infusing isotonic saline. Feed intake and the number of the rumination periods were recorded during test days. The proportion of feed eaten during each test meal (EatPro) was related to the mean plasma FCa. An almost linear decrease in EatPro was observed when the plasma FCa was 0.6-0.9 mmol/L. The cows showed no other clinical signs of hypocalcaemia during Na2EDTA-infusion. The time spent chewing during eating and rumination, and the number of rumination periods during a test day, decreased with a decline in plasma FCa concentration. It was concluded that induced SCHC depresses the feed intake and ruminative activity of dairy cows.

Hypocalcemia at parturition as a risk factor for left displacement of the abomasum in dairy cows

Summary Total and ionized serum calcium concentrations were measured in 510 Holstein cows at the time of parturition. Cows that subsequently developed left displacement of the abomasum (lda) were compared with those that did not. Cows that were hypocalcemic at parturition had a 4.8 times greater risk of developing lda than did normocalcemic cows. Hypocalcemia was associated with the development of lda whether ionized serum calcium concentration or total serum calcium concentration was used to determine whether cows were hypo- or normocalcemic. The proportion of cows developing lda was not significantly different between cows that had clinical signs of hypocalcemia and were treated for parturient paresis and cows that were hypocalcemic but did not have clinical signs and were not treated.

Parturient Paresis and Hypocalcemia in Ruminant Livestock

Parturient paresis (hypocalcemia) is most likely to affect dairy cattle around the time of parturition. It causes progressive neuromuscular dysfunction and flaccid paralysis. Older dairy cows, cows with a history of parturient paresis during a previous lactation, high-producing cows, and cows from the Jersey and Guernsey breeds are at highest risk for developing parturient paresis. Nonparturient hypocalcemia may also occur and is related to events other than parturition, such as severe stress, that temporarily overwhelm the mechanisms of calcium homeostasis. Beef cattle, sheep, and goats are affected less frequently by hypocalcemia than are dairy cows. Because these species are not as stressed for milk production as dairy cattle, nonparturient hypocalcemia makes up a higher proportion of cases in nondairy ruminants. Clinical signs of hypocalcemia in beef cattle, sheep, and goats tend toward hyperesthesia and tetany rather than the classic flaccid paralysis that occurs in dairy cattle with parturient hypocalcemia. Prompt and effective treatment of hypocalcemia helps to reduce the incidence of secondary complications, such as muscle damage or mastitis. The standard treatment regimen of 500 ml of 23 per cent calcium gluconate, administered intravenously, will elicit a favorable response in approximately 75 per cent of recumbent cows within 2 hours of treatment. Relapses following successful initial therapy are common and may be prevented in part by supplementation of intravenous treatment with an additional 500 ml of 23 per cent calcium gluconate administered subcutaneously. Proper nursing care following treatment speeds recovery and reduces the incidence of secondary complications owing to hypocalcemia.