ELECTROLYTE BALANCE – CALCIUM (HYPERCALCEMIA / HYPOCALCEMIA)

Electrolyte Balance – Calcium (Hypercalcemia / Hypocalcemia)

Definition Electrolyte balance is the delicate balance of essential minerals like calcium, sodium, potassium, and chloride in our body.

Types with Explanation Calcium is a crucial mineral that plays a vital role in various bodily functions like muscle contraction, nerve function, and blood clotting. It exists in two forms in the body: ionized (free) calcium and bound calcium.

Hypercalcemia (Elevated Calcium Levels)

Causes

1. Primary hyperparathyroidism → parathyroid glands produce excess parathyroid hormone (PTH)
2. Malignancy → cancer cells release PTH-related protein (PTHrP)
3. Vitamin D toxicity → excessive intake of vitamin D leads to increased calcium absorption
4. Prolonged immobilization → bone resorption leads to increased calcium levels
5. Thiazide diuretics → increased calcium reabsorption in the kidneys
6. Familial hypocalciuric hypercalcemia → genetic disorder leading to increased PTH secretion

Clinical Features

1. Nausea and vomiting
2. Abdominal cramps
3. Constipation
4. Fatigue
5. Weakness
6. Confusion
7. Headache
8. Muscle weakness

Diagnosis

1. Serum calcium level > 10.5 mg/dL
2. Serum PTH level > 65 pg/mL
3. 24-hour urinary calcium excretion > 400 mg
4. Bone scan to rule out malignancy

Complications

1. Kidney stones
2. Pancreatitis
3. Cardiac arrhythmias
4. Confusion and seizures

Management

1. Rest and hydration → fluid replacement to dilute calcium levels
2. Bisphosphonates → inhibit bone resorption
3. Calcimimetics → mimic the action of PTH
4. Denosumab → inhibit bone resorption
5. Surgery → remove parathyroid glands or tumors

Hypocalcemia (Low Calcium Levels)

Causes

1. Hypoparathyroidism → underactive parathyroid glands
2. Vitamin D deficiency → decreased calcium absorption
3. Prolonged immobilization → bone resorption leads to decreased calcium levels
4. Kidney failure → decreased calcium reabsorption
5. Magnesium deficiency → decreased calcium absorption
6. Alkaline phosphatase inhibitors → decreased bone formation

Clinical Features

1. Tingling and numbness in hands and feet
2. Muscle cramps
3. Weakness
4. Fatigue
5. Confusion
6. Seizures
7. Cardiac arrhythmias

Diagnosis

1. Serum calcium level < 8.6 mg/dL
2. Serum PTH level < 15 pg/mL
3. 24-hour urinary calcium excretion < 100 mg
4. Bone scan to rule out malignancy

Complications

1. Tetany
2. Seizures
3. Cardiac arrhythmias
4. Osteoporosis

Management

1. Calcium supplements → oral or intravenous administration
2. Vitamin D supplements → increase calcium absorption
3. Calcitriol → stimulate PTH secretion
4. Parathyroid hormone (PTH) therapy → mimic the action of PTH
5. Surgery → remove parathyroid glands or tumors

Homoeopathic Therapeutic Approach

1. Calcarea carbonica → for hypercalcemia
2. Calcarea phosphorica → for hypocalcemia
3. Natrum muriaticum → for hypocalcemia
4. Ferrum phosphoricum → for hypocalcemia