Biochemical assessment of calcium

Biochemical assessment of calcium:

Calcium;

Calcium is an essential micro nutrient required for teeth and bones formation, and blood clothing . Out of about 1200mg calcium in the adult body, 99% is part of the bones and teeth. The remaining 1% is found in extracellular fluids, cell membrane and intracellular structure..

Overview;

Calcium plays a fundamental role in many physiological processes such as nerve transmission, muscle contraction, blood coagulation, and cellular signaling. Thus, maintaining the correct calcium balance in the body is crucial. The biochemical assessment of calcium, which involves evaluating calcium concentration in the blood and urine, is an important tool for diagnosing and managing a wide range of medical conditions, from kidney disease to osteoporosis.

Ionized Calcium Measurement:

Ionized calcium is the biologically active form of calcium in the body. It is typically measured in patients with suspected disorders of calcium metabolism when the total serum calcium level is not reflective of the patient's clinical status, such as in cases of hypoalbuminemia or acid-base disorders.

Other Laboratory Tests:

To accurately interpret calcium levels, it is often necessary to concurrently evaluate other laboratory values, such as phosphorus, magnesium, vitamin D, and parathyroid hormone (PTH). PTH is particularly important as it is a key regulator of calcium homeostasis.

Conditions Affecting Calcium Levels:

Abnormal calcium levels can be indicative of a variety of health issues:

Hypercalcemia (high calcium levels) can be caused by hyperparathyroidism, cancer, certain medications, and overuse of calcium and vitamin D supplements.

Hypocalcemia (low calcium levels) can result from hypoparathyroidism, vitamin D deficiency, chronic kidney disease, and certain medications.

Osteoporosis, osteomalacia and rickets ae linked to low intake of calcium, particularly among women and children..

Deficiency of calcium;

Calcium uptake or absorption is linked with multiple factors. For example, optimal ratio of phosphorus i necessary for maximum utilization of calcium equilibrium within the blood stream. When calcium deficiency occurs, vitamin D and parathyroid play their role and transfer calcium from bones into blood to maintain mineral presence in bloodstream .

The mild deficiency due to inadequate dietary intake leads to osteoporosis, osteomalacia and rickets.

Measurement of calcium status:

Increased incidence of osteoporosis especially among women make it a public health issue. No appropriate biochemical methods are available currently assessment of calcium status. Owing to large calcium deposits in skeleton, calcium deficiency at tissues, cell, serum is hardly encountered.

Three potential approaches are practiced for calcium assessment; accounting for bone mineral content, biochemical markers and calcium metabolism measurements.

Serum calcium fractions:

Serum calcium is present in three forms; protein-bound, complexes with other minerals and ionized. Protein bounded calcium is physiologically inactive, whereas, ionized calcium exist in active form and perform intracellular regulatory functions. Complex calcium is present with negative ions and its role is undefined.

Altered levels of serum calcium are rare and indicate serious metabolic problems rather than dietary inadequacy and excess. Multiple factors influence serum calcium concentration low level in serum can be a result of hypoparathyroidism, acute pancreatitis and renal disease.

High serum concentration results hypercalcemia attributed to increase intestinal absorption, bone reabsorption, renal tubular reabsorption resulting from conditions such as hyperthyroidism, hyperparathyroidism, hypervitaminosis.

Urinary calcium:

Urinary calcium levels are more sensitive to changes in dietary calcium than in serum. However, urinary calcium is affected by several factors, including those leading to hypercalcemia. When serum level of calcium are high more calcium is available to be excreted through the urine.

Furthermore, there is a diurnal variation of calcium, with concentrations higher during the day and lower in the evening. Calcium output tends to increase with the intake of diet rich in protein and low of phosphate, while protein enrich diet which is high in phosphate led to low calcium output. Apart, urinary calcium losses are increased when volume of urine output is higher and kidneys ability to reabsorb calcium is impaired.

Usage of calcium to creatinine ratio calculated from 2 hour fasting urine sample has been suggested as a possible indicator of health status.

Conclusion:

The biochemical assessment of calcium, while a routine part of most metabolic panels, is a powerful tool that can provide key information about a patient's overall health and help diagnose various metabolic, renal, and bone diseases. Its interpretation requires consideration of other laboratory tests and the patient's clinical status. As such, any anomalies found during these assessments should be followed up with further investigation to pinpoint the cause and determine the appropriate treatment strategy.

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