Rashin lafiya

Hypocalcemia wani yanayi ne na kiwon lafiya wanda ke nuna ƙananan matakan calcium a cikin jini. Yankin al'ada na calcium na jini yawanci yana tsakanin 2.1-2.6

L (8.8-10.7 mg / dL, 4.3-5.2 mEq / L), yayin da matakan da ke ƙasa da 2.1 mmol / l an bayyana su a matsayin hypocalcemic. Ƙananan matakan da ke tasowa a hankali sau da yawa ba su da alamun bayyanar cututtuka. In ba haka ba alamun na iya haɗawa da Rashin ƙarfi, spasms na tsoka, convulsions, rikicewa, ko a cikin matsanancin yanayin dakatar da zuciya.   

Dalilin da ya fi dacewa da hypocalcemia shine iatrogenic hypoparathyroidism. Sauran dalilai sun haɗa da wasu nau'ikan hypoparathyroidism, karancin bitamin D, gazawar koda, pancreatitis, mai hana tashar calcium, rhabdomyolysis, ciwon lysis, da magunguna kamar bisphosphonates ko denosumab. Ya kamata a tabbatar da ganewar asali ta hanyar tantance matakin calcium da aka gyara ko matakin calcium mai ionized. Hakanan ana iya ganin takamaiman canje-canje a kan electrocardiogram (ECG).

Magani na farko don cututtuka masu tsanani shine tare da intravenous calcium chloride kuma mai yiwuwa Magnesium_sulfate" id="mwhA" rel="mw:WikiLink" title="Magnesium sulfate">magnesium sulfate. Sauran jiyya na iya haɗawa da Bitamin D, magnesium, da kari na calcium. Idan saboda hypoparathyroidism, ana iya ba da shawarar hydrochlorothiazide, phosphate binders, da kuma abincin gishiri. Kimanin kashi 18% na mutanen da ake kula da su a asibiti suna da hypocalcemia.

Alamomi da alamomi

Purpura

Alamun neuromuscular na hypocalcemia suna haifar da sakamako mai kyau na bathmotropic (watau ƙara yawan amsawa) saboda raguwar hulɗar calcium tare da tashoshi na sodium.  Tun da calcium yana toshe tashoshin sodium kuma yana hana depolarization na jijiyoyi da filaye na tsoka, rage yawan calcium yana rage kofa don ƙaddamarwa.[1]  Ana iya tunawa da alamun ta hanyar mnemonic "CATs go numb" - jujjuyawa, arrhythmias, tetany, da lanƙwasa a hannaye da ƙafafu da kewayen baki.  [

• Petechiae which appear as on-off spots, then later become confluent, and appear as purpura (larger bruised areas, usually in dependent regions of the body).
• Oral, perioral, and acral paresthesias, tingling or 'pins and needles' sensation in and around the mouth and lips, and in the extremities of the hands and feet. This is often the earliest symptom of hypocalcaemia.
• Carpopedal and generalized tetany (unrelieved and strong contractions of the hands, and in the large muscles of the rest of the body) are seen.
• Latent tetany
  • Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
  • Chvostek's sign (tapping of the inferior portion of the cheekbone will produce facial spasms)
• Tendon reflexes are hyperactive
• Life-threatening complications
  • Cardiac arrhythmias
• Effects on cardiac output
  • Negative chronotropic effect, or a decrease in heart rate.
  • Negative inotropic effect, or a decrease in contractility
• ECG changes include the following:
  • Intermittent QT prolongation, or intermittent prolongation of the QTc (corrected QT interval) on the ECG (electrocardiogram) is noted. The implications of intermittent QTc prolongation predispose to life-threatening cardiac electrical instability (and this is therefore a more critical condition than constant QTc prolongation). This type of electrical instability puts the person at high risk of torsades de pointes, a specific type of ventricular tachycardia which appears on an EKG (or ECG) as something that looks a bit like a sine wave with a regularly increasing and decreasing amplitude. (Torsades de pointes can cause death unless the person can be medically or electrically cardioverted and returned to a normal cardiac rhythm.)

Dalilan da suka haifar

Hypoparathyroidism shine cuta mai gama gari na hypocalcemia.]  Calcium an tsara shi sosai ta hanyar hormone parathyroid (PTH).  Dangane da ƙananan matakan calcium, matakan PTH sun tashi, kuma akasin haka, idan akwai matakan calcium mai girma, to, asirin PTH ya ragu.  Duk da haka, a cikin yanayin rashin, raguwa, ko rashin tasiri na hormone PTH, jiki ya rasa wannan aikin kulawa, kuma hypocalcemia yana faruwa.  Hypoparathyroidism yawanci saboda lalata glandan parathyroid na tiyata.[1]  Hypoparathyroidism na iya zama saboda matsalar autoimmune.  Wasu dalilai na hypocalcemia sune kamar haka:

• Hyperphosphatemia
• Vitamin D deficiency
• Chronic liver disease
• Edetate disodium
• Magnesium deficiency
• Prolonged use of medications/laxatives (magnesium)
• Osteomalacia
• Chronic kidney failure
• Ineffective active vitamin D
• Hypoparathyroidism/genetic
• After surgery hypoparathyroidism
• Hungry bone syndrome
• Tumour lysis syndrome
• Acute kidney injury
• Rhabdomyolysis (initial stage)
• As a complication of pancreatitis
• Alkalosis
• Massive red blood cell transfusion due to excess citrate in the blood
• As blood plasma hydrogen ion concentration decreases, caused by respiratory or metabolic alkalosis, the concentration of freely ionized calcium, the biologically active component of blood calcium, decreases. Because a portion of both hydrogen ions and calcium are bound to serum albumin, when blood becomes alkalotic, the bound hydrogen ions dissociate from albumin, freeing up the albumin to bind with more calcium and thereby decreasing the freely ionized portion of total serum calcium. For every 0.1 increase in pH, ionized calcium decreases by about 0.05 mmol/L. This hypocalcaemia related to alkalosis is partially responsible for the cerebral vasoconstriction that causes the lightheadedness, fainting, and paraesthesia often seen with hyperventilation.
• Neonatal hypocalcemia
• Gain of function mutations of the calcium-sensing receptor
• Foscarnet use
• Loop diuretic use
• Crohn disease
• High level of lactic acid in the blood
• Pseudohypoparathyroidism
• Trauma

Ilimin jiki

A fannin ilimin lissafi, ana sarrafa calcium na jini sosai a cikin wani yanki mai zurfi don hanyoyin salula masu kyau. Calcium a cikin jini yana cikin manyan jihohi guda uku: an ɗaure shi da sunadarai (musamman albumin), an ɗaure su da anions kamar phosphate da citrate, kuma a matsayin kyauta (marasa ɗaurewa) calcium ionized. Sai kawai calcium da ba a haɗa shi ba ne ke aiki a cikin jiki. Matsayin calcium na jini na yau da kullun yana tsakanin 8.5 da 10.5 MG / dl (2.12 zuwa 2.62 mmol / L) kuma na calcium wanda ba a haɗa shi ba shine 4.65 zuwa 5.25 MG / dl (1.16 zuwa 1.31 mmol / l).     

Hanyar aiki

Matakan Ca²⁺ na waje suna daidaita yanayin buɗewa na Tashoshin sodium masu ƙarfin lantarki, mai yiwuwa ta hanyar ɗaurewa a kan ɓangaren waje na tashar, don haka canza cajin lantarki na gida a tashar. Tare da raguwar matakan Ca2 + na extracellular, tashoshin Na + za su iya buɗewa a ci gaba da ƙarancin membrane, wanda ke haifar da tashin hankali. Lokacin da extracellular Ca2 + concentrations ya kai rabin na al'ada, wuce gona da iri na tashoshin Na + ya isa ya sa wasu jijiyoyin da ke kewaye su fara fitarwa ba tare da la'akari ba.

ECG na mutumin da ke fama da hypocalcemia

Saboda wani bangare mai mahimmanci na calcium yana ɗaure zuwa albumin, duk wani canji a matakin albumin zai shafi matakin da aka auna na calcium. Matsayin calcium da aka gyara bisa ga matakin albumin shine: Calcium da aka yi gyara (mg / dL) = auna jimlar Ca (mg / dl) + 0.8 * (4.0 - serum albumin [g / dL]).

Since calcium is also bound to small anions, it may be more useful to correct total calcium for both albumin and the anion gap.

Gudanarwa

• Ana iya gudanar da gluconate 10% na calcium a cikin jini, ko kuma idan hypocalcaemia yana da tsanani, ana ba da calcium chloride a maimakon haka. Wannan ya dace ne kawai idan hypocalcemia yana da tsanani kuma ya faru a cikin ɗan gajeren lokaci. Amma idan hypocalcemia ya kasance mai tsanani kuma mai tsanani, to wannan tsarin na iya zama mai kisa, saboda akwai matakin daidaitawa da ke faruwa. Rashin tashin hankali na neuromuscular, rashin daidaituwa na lantarki na zuciya, da alamun da ke tattare da su ba a warke su ba ko kuma a sauƙaƙe su ta hanyar gudanar da sassan gyaran calcium amma sun kara tsanantawa. Irin wannan saurin gudanar da calcium zai haifar da ingantaccen gyare-gyare - alamun hypercalcemia zasu biyo baya. [ana buƙatar ƙa'ida]
• Koyaya, a kowane yanayi, sassan kiyayewa na duka calcium da bitamin D (sau da yawa kamar 1,₂- (OH) 2-D₃, watau, calcitriol) sau da yawa suna da muhimmanci don hana ci gaba da raguwa. [ana buƙatar ƙa'ida]

• Rashin zazzabin madara (hypocalcemia a cikin dabbobi)
• Rashin calcium (rashin lafiya na shuka)
• Hypomagnesemia tare da hypocalcemia na biyu