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Calcium, CaMetabolism Calcium is mainly absorbed in the duodenum. Increased absorption in acid environments high levels increase PTH PTH decreases absorption and increases bone deposition low levels increase calcitonin calcitonin stimulates hydroxylation of 25 HCC into 24,25 DHCC Functions calcium ions add hardness to the bone matrix calcium aids transport across cell membranes for muscle contraction ionized calcium initiates formation of blood clotting stimulates the release of thromboplastin from platelets cofactor in the conversion of prothrombin to thrombin calcium maintains proper contractility of smooth and skeletal muscle Requirements RDA - adults - 800 mg, teenagers - 1200 mg children - 700 mg, infants - 400 mg Sources cheese Interactions Thyroid - excessive thyroid hormone causes excess excretion Digoxin - may exacerbate toxicity if given without magnesium Tetracyclines - inhibit calcium absorption and vice versa Corticosteroids - cause osteoporosis and calcium loss Aluminum - calcium reduces aluminum absorption Hypocalcemia Signs - abdominal and muscular cramps muscle spasm and tetany, particularly in the legs circumoral tingling, especially in the fingers convulsions Symptoms Trousseau sign: carpal spasm induced by occluding brachial artery Chovstek sign: facial muscle contraction induced by tapping facial nerve Complications osteoporosis, osteomalacia Etiology acute pancreatitis, chronic renal insufficiency, burns removal of parathyroid glands malabsorption syndrome Hypercalcemia Etiology excessive intake of vitamin D (milk) hypothyroidism, thyrtoxicosis, parathyroid neoplasm immobilization Paget's disease Signs anorexia, nausea lethargy, weight loss, polydypsia, polyuria flank pain, bone pain, decreased muscle tone Toxicity contraindicated in asthma due to phospholipase A2 potentiation may cause kidney stones (except citrate form) Rx sodium salts IV and diuretics (Lasix) Therapeutics EENT periodontal disease Musculoskeletal osteoporosis - adds hardness to the bone matrix restless leg, arthritis Cardiac hypertension - particularly for salt-sensitive people hypercholesterolemia - lowers cholesterol Urology calcium oxylate stones - binds to oxalate, decreases urinary oxalate Neurology insomnia, anxiety, hyperactivity, depression Oncology prevention of colon cancer Hematology blood clotting disorders - initiates formation of blood clotting Misc aluminum toxicity - PTH increases uptake of aluminum lead toxicity Sources Marz DeGowin, pg 766 Smith, NCLEX Review, pg 229
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