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It is a chemical element with the symbol Ca and atomic
number 20.
ͻ It has atomic mass of 40.078.
ͻ It is the fifth most abundant element by mass in the
earth͛s crust.
ͻ It is a soft gray alkaline earth metal.
ͻ It is also the fifth most abundant dissolved ion in seawater
by both molarity and mass.
ͻ It is the most abundant mineral in the body
O Yequired for the formation of bone and teeth

O For blood clotting and coagulation

O Normal muscle function: such as cardiac contraction and

skeletal muscle contraction

O Normal heart rhythms

O Normal nerve function and transmission of neural impulses.

O Calcium is a positively charged ion or cation. It can
be found in both extracellular fluid and
intracellular fluid.

O 99% of the body͛s calcium is found in bones and

teeth.

O 1% is found in serum and in soft tissue

1) The most common or ordered test is a total serum
calcium level.

2) Second measures various forms of calcium in

extra cellular fluid.
O The first test is the most common test .
Test measures the total amount of serum calcium
Normal range is 8.5 to 10.5 mg/dl

O Second test measures the various forms of calcium and

extracellular fluid.
41 % of extracellular calcium is bound to protein
9% bound to citrate or other organic ions
Approximately ½ is ionized (free calcium) , the only active form of
calcium
Causes:
O è Inadequate dietary intake of calcium or vitamin D
O è Yespiratory alkalosis r/t Hyperventilation
O è Yenal failure and those on Loop Diuretics
O è 6urn Patients (calcium can become trapped in burned tissue.)
O è Hypoparathyroidism
O è Hyperphosphatemia
O è Abuse of Phosphate containing antacids
O Chvostek͛s sign (twitching of facial nerve in
response to a tap on the nerve)

O Trousseau͛ sign (spasm of forearm on obstruction

of its blood supply)

O Tetany (worst form of laryngospasm)

O Later signs: Arrythmias

 Yight arm of patient showing positive Trousseau sign
(carpopedal spasm) induced by occluding circulation
in the arm with a blood pressure cuff

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O Increased intake of calcium rich foods (dairy

products, carrots, broccoli, green beans and
spinach.)
O Calcium Supplements (1-1.5 hours after
meals.)
O Calcium Gluconate IV or Calcium Chloride.
Watch closely for cardiac rhythm changes.)
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O Lethargy
O Weakness
O Personality changes
O Abdominal pain
O Constipation
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1. If patient is to have a total serum calcium
level checked, what other chemistry should
be considered?

A) C6C
6) CMP
C) 6one Density
D) Serum Albumin
O Serum Albumin

O 6ecause calcium binds to Albumin, so if the

the calcium level is low the Albumin level
will be low as well
2.) A 25 year old female underwent a bone
density exam. The results indicated low
mineral levels and small percentage of bone
loss. This is an indication of early signs of͙.

O A) Iron defiency - anemia

O 6) Hyperkalemia
O C) Osteoporosis
O D) 6one cancer
Osteoporosis
Î) A 5 year child old was seen by his pediatrician the
Dr. prescribed a calcium supplement due to a low
calcium level. On the patient͛s follow up visit a
new calcium test revealed low levels still. In
addition to taking a supplement the dr.
recommended that Mom do which of the
following: (select all that apply)

O A) Drink milk
O 6) Have child play outside in the sun
O C) Consume more Spinach or Kale
O D) Double the calcium supplement intake
4) A patient presents to the EY stuporous and with
6radycardia. The pt. suddenly went into cardiac
arrest and slipped into a coma. Chemistries were
evaluated and serum calcium level was 11.5 mg/dl.
What condition could have contributed to the Pt.
slipping into a coma?

O A) Hypermagnesia
O 6) Hyperkalemia
O C) Hyponatremia
O D) Hypercalcemia
O D) Hypercalcemia
5) Patient has an increased Albumin level and is
unable to absorb calcium. What is
contributing to the patients inability to
absorb the calcium?

O A) Albumin binds with calcium and so it renders it ineffective.

O 6) High PTH level
O C) Patient is immunocompromised
O D) Decreased protein level
O A) Albumin binds with calcium and so it
renders it ineffective.
 Calcium Yobbers
O A high protein diet can increase calcium loss.
O Too much caffeine or too many soft drinks can also inhibit calcium
absorption.
O Low levels of vitamin D. Vitamin D is needed for calcium to be absorbed
in the GI tract.
O Fiber interferes with absorption of calcium particularly bean, nut, wheat
bran or seed fiber
O Too much salt. This can cause calcium to be lost through the kidney

 Calcium Yobbers Cont...

O Certain medications such as water pills (diuretics), steroids,
anti-seizure medications, immunosuppressive medications,
non-steroidal anti-inflammatory drugs ( NSAIDs like
ibuprofen, naproxen), asthma medication with steroids
O Oxalic acid in spinach and Swiss chard, rhubarb, almonds
and chocolate combine with calcium to form calcium
oxalate, a salt the body can not use.
O Lifestyle choices such as cigarette use, more than 2 alcoholic
drinks a day.
O Sedentary lifestyle. The lack of weight bearing exercise
such as walking, running, weight lifting will decrease bone
mass.
O On the other hand too much calcium block the absorption
of iron and zinc
i
http://dietary-
supplements.info.nih.gov/factsheets/calcium.asp

Lippencott, Williams & Wilkins, Fluids & Electrolytes made

Incredibly Easy. (2005) New York: Wolters Kluwer
Publishing

http://www.youtube.com/watch?v=8D1L-Id_hYg

6arefoot, Yobert Y. and Carl J. Yeich, MD. (2002) The Calcium

Factor: The Scientific Secret of Health and Youth.
Wickenburg, PA: Deonna Enterprises Publishing