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1. Hypercalcemia & Hypocalcemia by Nora Khreba

2. Ca2+ Homeostasis

3. Ca2+ Homeostasis

4. Factors affecting Ca concentration:

5. Factors which Influence the Concentration of Ionised Calcium

6. Effect of acid base abnormality

7. Ca2+ Homeostasis

8. PTH

9. Regulation of PTH by plasma Ca concentration

10. Actions on bone:

11. Vitamin D

12. Actions of Vit D :

13. calcitonin

14. Ca2+-Sensing Receptor ( CaSR )

15. Ca2+-Sensing Receptor (CaSR)

16. Renal handling of Ca

17. PCT

18. Thick ascending limb of loop of henle

19. distal convulted tubule

20. Renal handling of Ca No calcium reabsorption is taking place in this segment, which totally depends on the calcium load delivered by the CNT. Apical CaSR-like proteins sense urine calcium concentration. This leads to inhibition of water reabsorption and stimulates urine acidification, decreasing the risk of stone formation

21. Effect of various factors on Ca2+ reabsorption in the nephron

22. Factors that increase and decrease TRPV5 activity

23. Hypocalcemia Plasma [Ca2+] <8.5 mg/dL For each gram decrease of albumin from normal (i.e., 4.0 g/dL), [Ca2+] decreases by 0.8 mg/dL.

24. Role of Ca

25. Clinical manifestations of hypocalcemia

26. ECG manifestation of hypocalcemia

27. corrected QT interval

28. Causes of hypocalcemia

29. Causes of hypocalcemia

30. Causes of hypocalcemia

31. Causes of hypocalcemia

32. Causes of hypocalcemia

33. Causes of hypocalcemia

34. Diagnostic approach to a patient with hypocalcemia

35. Treatment of Acute Hypocalcemia

36. Treatment Acute Hypocalcemia Initially, one to two ampules of calcium gluconate in 50 mL of 5% dextrose should be given over a period of 10–20 min, followed by 0.3–1 mg of elemental Ca2+/kg/h, if necessary. Once symptoms improve, the patient can be started on oral Ca2+ tablets In order to increase total serum Ca2+ by 2–3 mg/dL, a 70 kg patient requires 1 g of elemental Ca2+ (approximately ten ampules of calcium gluconate).

37. precautions

38. Oral calcium preparations

39. Treatment chronic Hypocalcemia Treatment is aimed at correcting the cause, if possible. Oral calcium supplementation (500–1,500 mg elemental Ca2+) calcitriol 0.5–1 μ g/day are generally used for patients with hypoparathyroidism or PTH resistance, chronic kidney disease, and osteomalacia . A few patients with hypoparathyroidism may benefit from thiazide diuretics. For patients with nutritional vitamin D deficiency, either cholecalciferol (effective dose 400–1,000 U/day) or ergocalciferol (effective dose 25,000– 50,000 U three times/week) can be used. For many patients,

40. Empirical Ca administration prior to dialysis in ESRD patient , first discovered , presented with emergency in need for urgent dialysis?????

41. Hypercalcemia serum [Ca2+] >10.2 mg/dL in an individual with normal serum albumin concentration. severe hypercalcemia is considered when serum [Ca2+] is above 14 mg/dL.

42. Clinical manifestations of hypercalcemia

43. Clinical manifestations of hypercalcemia

44. ECG manifestation of hypocalcemia

45. Causes of hypercalcemia

46. Causes of hypercalcemia

47. Causes of hypercalcemia

48. Diagnostic approach to a patient with hypocalcemia

49. Treatment of acute hypercalcemia 1. Hydration with normal saline and then administration of furosemide for volume overload. Note that furosemide-induced volume depletion may increase reabsorption of Ca2+ by the proximal tubule 2. Inhibition of bone resorption of Ca2+. 3. Decrease intestinal absorption of Ca2+. 4. Removal of Ca2+ by hemodialysis using a dialysate bath containing low Ca2+.

50. Treatment of acute hypercalcemia

51. Treatment of acute hypercalcemia

52. Treatment of chronic hypercalcemia

53. Treatment of chronic hypercalcemia