Hypercalcaemia and Hypocalcaemia

Hypercalcaemia and Hypocalcaemia

Calcium (Ca++)

Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Having the right amount of calcium is important for building and keeping strong bones

Normal serum level is 8.5 to 10 .5 mg/dl. An increase in pH causes a fall in the ionized proportion of calcium. Calcium imbalance is not frequently encountered.

Functions of calcium in the body

Bone health: Around 99% of the calcium in the human body is in the bones and teeth. Calcium is essential for the development, growth, and maintenance of bone.

As children grow, calcium contributes to the development of their bones. After a person stops growing, calcium continues to help maintain the bones and slow down bone density loss, which is a natural part of the aging process.

Females who have already experienced menopause can lose bone density at a higher rate than males or younger people. They have a higher risk of developing osteoporosis, and a doctor may recommend calcium supplements.


Muscle contraction: Calcium helps regulate muscle contraction. When a nerve stimulates a muscle, the body releases calcium. The calcium helps the proteins in muscle carry out the work of contraction.

When the body pumps the calcium out of the muscle, the muscle will relax.

Cardiovascular system: Calcium plays a key role in blood clotting. The process of clotting is complex and has a number of steps. These involve a range of chemicals, including calcium.

Calcium’s role in muscle function includes maintaining the action of the heart muscle. Calcium relaxes the smooth muscle that surrounds blood vessels. Various studies have indicated a possible link between high consumption of calcium and lower blood pressure.

Vitamin D is also essential for bone health, and it helps the body absorb calcium.

Foods rich in calcium

  • yogurt
  • milk
  • fortified dairy alternatives, such as soy milk
  • sardines and salmon
  • cheese
  • tofu
  • green leafy vegetables, such as broccoli, turnip leaves, watercress, and kale
  • many fortified breakfast cereals
  • fortified fruit juices
  • nuts and seeds, especially almonds, sesame, and chia
  • legumes and grains
  • cornmeal and corn tortillas

Some dark green vegetables, such as spinach, contain calcium. However, they also contain high levels of oxalic acid. Oxalic acid reduces the body’s ability to absorb calcium, according to studies.

Hypocalcaemia (serum level below 8mg/dl)

Hypocalcaemia is a state of electrolyte imbalance in which the circulating serum calcium level is low. During hypocalcaemia, the total calcium level and the ionised calcium level fall below the laboratory reference range.

Hypocalcaemia may occur subsequent to failure of any of the mechanisms by which serum calcium concentration is maintained. But it is usually the result of failure of parathyroid hormone secretion or an inability to release calcium from bone.

Signs and symptoms

Hypocalcaemia varies from a mild asymptomatic biochemical abnormality to a life-threatening disorder. Acute hypocalcaemia can lead to paraesthesia, tetany, and seizures (characteristic physical signs may be observed, including Chvostek’s sign, which is poorly sensitive and specific of hypocalcaemia, and Trousseau’s sign).

Common causes include:

  • Hypoparathyroidism after thyroid surgery
  • Acute pancreatitis
  • Massive soft tissue infection (necrotizing fascitis) and
  • Pancreatic and small bowel fistulas

Treatment: IV Calcium gluconate (10ml of 10% solution over 10 minute) or calcium chloride. Calcium lactate may be given orally with or without Vitamin D.

Hypercalcaemia (serum calcium over10.5mg/dl)

Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much calcium in your blood can weaken your bones, create kidney stones, and interfere with how your heart and brain work.

Hypercalcemia is usually a result of overactive parathyroid glands. These four tiny glands are situated in the neck, near the thyroid gland. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements.

Signs and symptoms

  • Kidneys: Excess calcium makes your kidneys work harder to filter it. This can cause excessive thirst and frequent urination.
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  • Digestive system: Hypercalcemia can cause stomach upset, nausea, vomiting and constipation.
  • Bones and muscles: In most cases, the excess calcium in your blood was leached from your bones, which weakens them. This can cause bone pain and muscle weakness.
  • Brain: Hypercalcemia can interfere with how your brain works, resulting in confusion, lethargy and fatigue. It can also cause depression.
  • Heart: Rarely, severe hypercalcemia can interfere with your heart function, causing palpitations and fainting, indications of cardiac arrhythmia, and other heart problems.

Treatment: A serum level of calcium of 15 mg/dl or higher requires emergency treatment.

  • Vigorous volume repletion with salt solutions.
  • Oral or IV inorganic phosphate or mithramycin.

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