nursing 210

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