Clinical practice 2
MLT 463
By the end of this topic the student able to:
Define and classification of Calcium & Phosphorus.
State the clinical significance of Calcium & Phosphorus.
Discuss the changes of Calcium & phosphorus in hormonal diseases.
Specify the factors that affect the level of Calcium & Phosphorus.
Calcium and phosphate are both minerals that are important for you
to be healthy. Together, they help build strong bones and teeth, and
also play a role in cell and nerve function.
Blood tests Normal value
Calcium 8.5-10.4 mg/dl
Phosphorus 2.5-5.1 mg/dl
The total amount of calcium in the body averages 1.0 kg, about
99.8% of the body calcium is in bones and teeth, the remaining 0.2%
of total body calcium are present in soft tissues: extracellular fluid.
Blood calcium:
Little in red blood cells.
Most of the blood calcium is present in the blood plasma.
Plasma calcium exists in 2 forms:
1. Non-diffusible Form (40%):
Bound to plasma proteins, mainly albumin.
It is physiologically inactive.
2. Diffusible Form (60%):
Complexed Form (10%): Form citrate, phosphate, and bicarbonate salts.
Ionized Form (50%): This is mostly in the form of chloride salt.
Factors affecting plasma calcium level:
Parathyroid Hormone (PTH)& 2. Vitamin D: increases the plasma calcium level.
Calcitonin: decreases the plasma calcium level by inhibiting the mobilization of
calcium from bones.
Hypercalcemia:
Hyperproteinemia (False Hypercalcemia): In venous stasis and in
dehydration.
Hyperparathyroidism
Malignant Disease: Hypercalcemia occurs in multiple myeloma, bone
metastasis, and in some solid tumors.
Hypocalcemia:
Hypoproteinemia (False Hypocalcemia): 40% of plasma calcium is bound to
plasma proteins, hypoalbuminemia leads to hypocalcemia.
Prolonged Dietary Deficiency of Calcium: leads to depletion of calcium
stores and hypocalcemia.
Decreased Calcium Absorption: leads to hypocalcemia. Due to causes of
decreased calcium absorption mentioned.
Renal Failure: due to decreased activation of vitamin D.
Hypoparathyroidism
The total body phosphorus averages 0.8 Kg.
About 80% is found in the skeleton in the form of apatite salts.
20% is found in other tissues and body fluids, chiefly intracellularly, in the
form of inorganic and organic phosphates:
Inorganic: include sodium, potassium, calcium, and magnesium phosphates.
Organic: are esters of phosphoric acid with organic compounds, e.g., glucose 6-
phosphate and phospholipids.
Blood phosphate:
Red cell phosphate level is much higher than plasma phosphate level.
Plasma phosphate:
Organic phosphates: mostly phospholipids.
Inorganic phosphates: mostly in the form of sodium phosphate. Only
inorganic phosphate is clinically important.
Factors affecting plasma inorganic phosphate level and Clinical Applications:
Parathyroid Hormone: PHT enhances the uptake of phosphate from the
intestine and bones into the blood, but reduces the reabsorption
of phosphate from the proximal tubule of the kidney more phosphate
excreted through the urine small net drop in the serum concentration
of phosphate.
Vitamin D: increases the plasma phosphate level (↓ vitamin D level lead to ↓
phosphate level).
Renal Function: In renal failure the plasma inorganic phosphate level
increases due to failure of excretion in the urine.
36-year-old man attend to the endocrinologist, according to the
hormone levels the PTH was seriously decreased.
Questions:
1. Please comment.
2. Mention the factors that affect calcium and phosphorus levels.
A 72 years old female suffer from diabetes for along time progress to
chronic kidney failure, in last lab tests this results were obtained:
Test Result
Urea 187 g/dL
Creatinine 4.0 mg/dL
Calcium 6.8 mg/dL
Questions:
1. Please comment?
2. What is the expected phosphate result? why?
A 56-year-old female has a history of diabetes mellitus and
hypothyroidism, her chief complaint was elevated serum calcium
during a recent hospital admission. She has been having pain in her
legs, constipation, and occasional weakness.
Questions:
What is the cause for hypercalcemia?
What additional laboratory investigations should be performed and
why?
