Hypocalcemia
Description:
The hypocalcemia — a state at which the content of the general calcium in a blood plasma is lower than 1,87 mmol/l, and ionized — is lower than 1,07 mmol/l (Normal concentration of calcium in a blood plasma fluctuates from 2,2 to 2,5 mmol/l and correlates with the content of inorganic phosphorus from 0,65 to 1,6 mmol/l). Intracellular calcium makes about 180 pmol/L, that is is 10 000 times less than extracellular.
Hypocalcemia symptoms:
The hypoparathyrosis is defined as the state caused by reduction of secretion or peripheral effect of parathormone. Reduction of formation of parathormone causes direct decrease in a reabsorption of calcium in kidneys and the mediated reduction of its absorption in intestines which is carried out due to education reduction 1,25 D3 dihydroxyvitamins. Operative measures in a neck are the most common cause of deficit of PTG. Removal or damage of a parathyroid can be result of a thyroidectomy, parathyroidectomy and radical operation on bodies of a neck. The Posleoperationny hypocalcemia quite often arises even for lack of removal of a considerable part of fabric of a parathyroid, apparently, as a result of the ischemia developing as a result of a section of nearby fabrics. The postoperative hypoparathyrosis usually has passing character and exists within several days or weeks. The syndrome of "a hungry bone" represents one of forms of a passing hypoparathyrosis which often arises after removal of adenoma of a parathyroid or after a thyroidectomy concerning a hyperthyroidism.
The deficit of PTG arising for no apparent reason is called an idiopathic hypoparathyrosis; this syndrome covers diverse group of disturbances which have family or sporadic character. On the basis of detection of antibodies to fabric of a parathyroid and the autoimmune nature of associated diseases, including addisonovy disease, primary hypothyroidism, diabetes mellitus, primary hypogonadism and pernicious anemia, the autoimmune mechanism of an idiopathic hypoparathyrosis was proved. Such patients can have candidiasis of skin and mucous, a vitiligo and focal baldness. Other form of an idiopathic hypoparathyrosis represents the state which is arising sporadic at adult age and not having signs of autoimmune disorders; its etiology is unknown, however at a pathoanatomical research the parathyroid replacement of tissue fatty or fibrous tissue usually is found.
Destruction of epithelial bodies can arise also at other states resulting in deficit of PTG. According to messages, radiation injury as a result of treatment of a hyperthyroidism drugs of a radioiodine leads to the expressed hypoparathyrosis in exclusively exceptional cases. Parathyroid fabric infiltration by iron with the subsequent development of a hypoparathyrosis can arise at primary and secondary forms of hemochromatosis. Infiltration of parathyroids a metastatic tumor represents the frequent phenomenon, especially at a breast cancer, however destruction of gland has to have subtotal character in order that the hypocalcemia developed. Disturbances of embryonic development can lead to an underdevelopment thymic and parathyroids, or to Dee Gheorghe's syndrome.
Hypocalcemia reasons:
Hypoalbuminemia
Hypoparathyrosis
Postoperative
Idiopathic
Treatment by radioiodine drugs
Hemokhromatoz
Metastatic cancer
Dee Gheorghe's syndrome
Pseudohypoparathyroidism
Hypomagnesiemia
Deficit of vitamin D
Dietary
Disturbance of absorption in intestines
Liver diseases
Treatment by anticonvulsant drugs
Chronic renal failure
Inborn deficit of vitamin D
Resistance of target organs to vitamin D
Acute pancreatitis
Hyperphosphatemia
Blood transfusions
Cancer (osteoplastic metastasises)
Hypocalcemia of newborns
Treatment of the Hypocalcemia:
The hypocalcemia if there are no symptoms, demands additional reception of calcium inside and vitamin D for maintenance of concentration of serumal calcium within 7,5-8,5 mg/dl. When the content of calcium in serum sharply falls to the level at which the patient has disease symptoms, recommend additional intravenous administration of calcic drugs. The dose of calcium depends on the size of the atomic calcium delivered in this drug. About 90 mg of elementary calcium give intravenously once when rendering acute management in case of a hypocalcemia with the subsequent injection of 0,5-2,0 mg/kg/h.
