F&E

Calcium (8.6-10.L2 MG/DL)

 More than 99% of total body’s calcium is HYPERCALCEMIA
located in the skeletal muscle: major  is a dangerous imbalance when severe,
components of BONES & TEETH. hypercalcemia crisis has a mortality rate as
 1% of skeletal calcium is rapidly high as 50% if not treated promptly
exchangeable with blood calcium and the
rest is more stable and only slowly Sign & Symptoms
exchanged  SWOLLEN and SLOW - Moan, Groans,
 Small amount of calcium located outside and Stones
the bone circulates in the serum partly  Constipation - due to swollen slow GI
bound to protein and partly ionized.  Bone pain - calcium leaving the bone
 Major role in transmitting nerve impulses  Stones renal calculi (kidney stones)
and helps regulate muscle contraction and  Deep tendon reflexes - swollen and swell
relaxation, including cardiac muscle DEEP DTR
 Instrumental in activating enzyme that SEVERE MUSCLE WEAKNESS
stimulates many essential chemical
reaction in the body  Cardiovascular changes may include a
 Play a role in blood circulation variety of dysrhythmias (heart blocks and
 Many factors affect calcium regulation, shortening of the QT interval and ST
both HYPER and HYPO are relatively segment)
common disturbance  The PR intervals is sometimes prolonged
 Absorbed from food in the presence of  The double anti body PTH test may be
normal gastric acidity and vitamin used to differentiate between primary
 Excreted primarily in the feces with the hyperparathyroidism and malignancy as a
remainder excreted in the urine cause of hypercalcemia.
 Serum calcium level is controlled by PTH  PTH level increase in primary or secondary
and Calcitonin hyperparathyroidism.
 Ionized calcium decreases parathyroid  PTH level suppressed in malignancy
glands secrete parathyroid hormones, this  Xray may reveal bone changes if the
in turn increases calcium absorption from patient has hypercalcemia secondary to
the GI Tract, increases calcium malignancy, (bone cavitation and calculi).
reabsorption for the Renal Tubules and  The sulkowitch urine test to analyze the
release calcium from the Bones amount of calcium in the urine, in
 The increase calcium concentration hypercalcemia, dense precipitation is
suppress PTH secretion, when calcium observed due to hypercalcemia
increases excessively, the thyroid gland
secretes Calcitonin, which inhibits calcium Medical Management
reabsorption from the bones and  Therapeutic aim include decreasing the serum
decreases serum calcium concentration level and reversing the process oh
hypercalcemia
Function of Calcium (3’s B)  Chemotherapy for malignancy
 Bones  Partial parathyroidectomy for
 Blood (Clotting factors) hyperparathyroidism.
 Beats (Heart beats)  Pharmacologic therapy including administering
fluid to dilute serum calcium and promote
excretion in the kidney
 Dietary restriction of calcium intake
 0.9 sodium chloride to dilute the serum

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calcium and increase urinary calcium
excretion.
 Iv phosphate can cause drop in serum calcium
 Furosemide in conjunction with administration
of sol. In addition to causing diuresis, Strong B's
furosemide increase calcium excretion  Bones - Risk for fracture
 Calcitonin can be used to lower serum calcium  Bloods - Risk for bleeding
and useful for patients with heart disease or  Beats - Cardiac dysrhythmias
renal failure who cannot tolerate large sodium
loads. Calcitonin reduce bone resorption, Factors can cause:
increased the deposition of ca and phosphorus  Primary hypoparathyroidism and surgical
in the bones, increases excretion of calcium hypoparathyroidism
and phosphorus.  It also occur after, radical neck dissection most
likely first 24 hours after surgery.
Nursing Management  Transient hypocálcemia occur with massive
 Increasing patient mobility and encouraging administration of citrated blood (massive
fluids can help prevent hypercalcemia. hemorrhage and shock) because citrate/can
 Fluid containing sodium should be administer combine with ionized calcium and temporarily
unless contraindicated, sodium assist in remove it from the circulation
calcium excretion.  Hypocalcemia occurs in common Pancreatitis,
 Encourage to drink 3-4 quartz of fluid daily. it causes breakdown of proteins and lipids. It is
 Increase fiber in diet to offset the tendency of thought that calcium ion combines with fatty
constipatio acids released by lipolysis, as a result
 Safety prec. if mental symptoms of hypocalcemia occurs.
hypercalcemia are presents  Hypocalcemia may be related to excessive
 Assess for signs and symptoms of digitalis secretion of glucagon from the inflammed
toxicity, increases calcium increases its effect. pancreas which results in increased secretion
Because ECG changes (premature ventricular of calcitoni
contraction, paroxysmal atrial tachycardia and  Hypocalcemia is common in patient with renal
heart block, therefore cardiac rate and rhythm failure because patient have elevated serum
are monitored. phosphate, hyperphosphatemai usually causes
a reciprocal drop in the serum calcium levels.
 Inadequate vitamin d consumption,
HYPOCALCEMIA magnesium deficiency, medullary thyroid
 Serum calcium lower than 8.6 occurs in a. carcinoma, low serum albumin level, alkalosis
Variety of clinical situations. and alcohol abuse
 A patient may have a total body calcium deficit  Medication predisposed to hypo: aliminum
(osteoporosis )but a normal serum calcium containing antacids, aminoglycosides, caffeine,
level cisplatin, corticosteroids, mithramycin,
 Elderly and those with disabilities, who spend phosphates, isoniazids and loop diuretics
an increased amount of time in bed, have a
high risk of hypocalcemia Clinical Manifestations
 Tetany most common characteristics of hypo
Sign and Symptoms calcium and magnesium.
 Trosseau's sign  Tingling sensation in fingertips, perioral, and
 Chvostek's sign less common in feet
 Diarrhe  Spasms of the muscles of extremities and face
 Circumoral tingling may occur.

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 Hyperactive DTR are another clinical signs  Airway closely monitoring - laryngeal stridor
associated with tetany can occur
 Trosseau’s sign - can be elicited by inflating a  Safety prec. for confused patient.
blood pressure cuff the upper arm to about 20  Dietary modification
mmhg above systolic pressure within 2-5  Alcohol and caffeine inhibit calcium absorption
minutes, carpal spasm (an adducted thumb,  Moderate cigarette smoking increases urinary
flexed wrist and metacarpophalangeal joints, calcium excretion
extended interphalangeal joints with finger  Patient also cautioned to avoid overuse of
together will occur as ischemia of the ulnar laxatives and antacids that contain phophorus,
nerve develops they decrease calcium absorption
 Chvostek's sign - twitching of muscles
enervated by the facial nerve when the region
that is about 2 cm anterior to the earlobe just
below the zygomatic arch
 Seizure may occur, increases the irritability of
CNS as well as the PNS
 Mental changes: depression, impaired
memory, confusion, delirium and hallucination.
 Prolonged QT interval is seen due to
prolongation of the ST segment and torsades
de pointes
 Respiratory effect of hypocal, dyspnea and
laryngospasm
 Chronic hypocal. Include hyperactive bowel
sounds, orty and bittle hair and nails and
abnormal clotting.

Medical Management
 Iv admin of calcium salts
 Parenteral calcium salts (CA gluconate,
calcium, chloride and calcium gluceptate)
 Too rapid admin of IV cal. can cause cardiac
arrest preceded by bradycardia.
 IV admin of calcium is dangerous in patient
receiving digitalis, because calcium ions exert
an effect similar to digitalis and cause digitalis
toxicity with adverse cardiac effect.
 IV site must be observe for infiltration because
of the risk of extravasation and resultant
cellulitis and necrosis.
 0.9 nacl should not be used with calcium
because it increases renal calcium loss.
 Calcium replacement
 Vitamin D therapy to increase calcium
absorption from the GI tract

Nursing Management
 Seizure precaution