Fall In Total Calcium Research Articles

Prophylactic administration of oral calcium carbonate during plateletpheresis: A bicentric prospective study

BACKGROUND:Administration of anticoagulant citrate and dextrose (ACD-A) chelates ionized calcium in blood and causes hypocalcemia in plateletpheresis donors. The aim of the study was to observe the effects of oral calcium (Ca) supplementation during plateletpheresis on various parameters related to calcium metabolism.MATERIALS AND METHODS:This study was performed between January 2014 and December 2014 on 200 plateletpheresis donors. They were divided into two groups. In group A donors (n=100), no prophylactic oral calcium supplementation was given. In group B (n=100) donors, 2000 mg of calcium was given one hour before the start of the procedure, 500 mg was given at the start of the procedure and 500 mg calcium was given just before the end of procedure. Biochemical parameters like serum total calcium (T Ca), serum total magnesium (T Mg) and ionized calcium level (iCa) were measured before and after the procedure. Relative risk of citrate toxicity was measured between the two groups.RESULTS:There was a significant fall in total calcium (pre 9.02 mg/dl, post 8.23 mg/dl,), ionized calcium level (pre 1.14 mmol/L, post 0.91 mmol/L) and total magnesium (pre 1.92 mg/dl, post 1.79 mg/dl) amongst the donors who did not receive prophylactic calcium supplementation. Despite calcium intake, in prophylactic calcium intake group, we did observe a significant drop in total magnesium (pre 2.04 mg/dl, post 1.94 mg/dl) and ionized calcium level (pre 1.25 mmol/L, post 1.12 mmol/L, p<0.01). We did observe a drop in total calcium level, however, this observation was not statistically significant. The risk (RR=5.44) of citrate toxicity was higher among group A donors.CONCLUSION:Prophylactic oral calcium carbonate supplementation would help in to reduce the risk of citrate toxicity. Therefore, we suggest for prophylactic oral administration of 3000 mg elemental calcium carbonate in three divided doses to make PP procedures uneventful.

Serum calcium and parathormone during normal pregnancy in Malay women.

To ascertain the calcium status in normal pregnant Malay women. In a cross-sectional study, serum parathormone (PTH) and calcium concentrations, and 24-h urinary calcium excretion were estimated in age-matched normotensive pregnant women, over the 3 trimesters. No statistically significant differences were evident in serum ionised calcium concentrations between the pregnant women in the 3 trimesters. Serum total calcium however, was significantly lower in women in the 3rd trimester of pregnancy (2.29+/-0.16, 2.26+/-0.13, and 2.16+/-0.12 mmol l(-1) in the 1st, 2nd, and 3rd trimesters, respectively; P < 0.001). Serum parathyroid hormone concentration was significantly higher in the 3rd trimester of pregnancy (3.37+/-3.31, 4.36+/-4.55, and 7.17+/-6.6 pg ml(-1) in the 1st, 2nd, and 3rd trimesters, respectively; P < 0.05). No significant differences were evident in serum sodium and potassium concentrations between the 3 groups. Urinary calcium excretion was significantly lower in women in the 3rd trimester of pregnancy (3.41+/-1.80, 3.56+/-3.31, and 2.46+/-1.71 mmol day(-1) in the 1st, 2nd, and in the 3rd trimesters, respectively; P < 0.05). No significant differences were evident in urine output, creatinine clearance, or in the excretion of sodium and potassium between the 3 groups. It appears that a significant fall in serum total calcium occurs in the 2nd half of normal human pregnancy when there is also an increased fetal demand and perhaps also a relatively insufficient maternal intake and/or intestinal absorption. The lower urinary calcium excretion probably occurs secondary to this and may suggest a fall in total body calcium and an attempt by the body to conserve calcium. While under normal circumstances, this level of fall in total calcium may not be significant, the coincidence of occurrence of hypertensive disorders of pregnancy during this stage of pregnancy, and the evident link between low calcium intake and pregnancy-induced hypertension (PIH) and its possible amelioration with calcium supplementation, suggests a need to assess calcium status in pregnant women with a view to providing calcium supplementation during pregnancy.

Serum calcium and parathormone during normal pregnancy in malay women

Objective: To ascertain the calcium status in normal pregnant Malay women.Methods: In a cross-sectional study, serum parathormone (PTH) and calcium concentrations, and 24-h urinary calcium excretion were estimated in age-matched normotensive pregnant women, over the 3 trimesters.Results: No statistically significant differences were evident in serum ionised calcium concentrations between the pregnant women in the 3 trimesters. Serum total calcium however, was significantly lower in women in the 3rd trimester of pregnancy (2.29 ± 0.16, 2.26 ± 0.13, and 2.16 ± 0.12 mmol l–1 in the 1st, 2nd, and 3rd trimesters, respectively; P < 0.001). Serum parathyroid hormone concentration was significantly higher in the 3rd trimester of pregnancy (3.37 ± 3.31, 4.36 ± 4.55, and 7.17 ± 6.6 pg ml–1 in the 1st, 2nd, and 3rd trimesters, respectively; P < 0.05). No significant differences were evident in serum sodium and potassium concentrations between the 3 groups. Urinary calcium excretion was significantly lower in women in the 3rd trimester of pregnancy (3.41 ± 1.80, 3.56 ± 3.31, and 2.46 ± 1.71 mmol day–1 in the 1st, 2nd, and in the 3rd trimesters, respectively; P < 0.05). No significant differences were evident in urine output, creatinine clearance, or in the excretion of sodium and potassium between the 3 groups.Conclusions: It appears that a significant fall in serum total calcium occurs in the 2nd half of normal human pregnancy when there is also an increased fetal demand and perhaps also a relatively insufficient maternal intake and/or intestinal absorption. The lower urinary calcium excretion probably occurs secondary to this and may suggest a fall in total body calcium and an attempt by the body to conserve calcium. While under normal circumstances, this level of fall in total calcium may not be significant, the coincidence of occurrence of hypertensive disorders of pregnancy during this stage of pregnancy, and the evident link between low calcium intake and pregnancy-induced hypertension (PIH) and its possible amelioration with calcium supplementation, suggests a need to assess calcium status in pregnant women with a view to providing calcium supplementation during pregnancy.

Hypocalcemia after an acute phosphate load is secondary to reduced calcium efflux from bone: studies in patients with minimal renal function and varying parathyroid activity.

Seven patients with severe hyperparathyroidism secondary to chronic renal failure, six patients with hypoparathyroidism after remote total parathyroidectomy also with chronic renal failure, and a miscellaneous group of three patients, some of whom were in the previous two groups, were studied on 24 occasions over a 6-h period. Each test consisted of a 2-h control period followed by a 4-h phosphate (Pi) infusion period. Radioactive calcium, 45Ca, had been administered the evening before. Samples were taken every 15 min throughout the 6-h study. In all tests, ionized and total calcium fell as Pi rose. Intact parathyroid hormone levels (PTH) rose, except in the hypoparathyroid patients, in whom there was no change. The decline in 45Ca activity was not affected by the Pi infusion, the fall being -0.131 +/- 0.057 cpm/min during the control period and -0.124 +/- 0.043 during the Pi infusion. There were no changes in pH, bicarbonate, electrolytes, or vitamin D metabolites during the procedure. The mean overall fall in total calcium was -0.118 mmol/mmol rise in Pi. For ionized calcium, it was -0.067 mmol/mmol Pi or 56.8% of the total calcium. This ratio was unchanged throughout the test period. With a steady flux of calcium from extracellular fluid (ECF) to bone as measured by 45Ca, the fall in ECF calcium has to be due to a decreased flux from bone to ECF. This could be produced by the reduced dissolution of a labile pool of a calcium salt such as brushite, CaHPO4.