Abnormalities in serum calcium concentration may have profound effects on neurological, gastrointestinal, and renal function. Maintenance of the normal serum calcium is a result of tightly regulated ion transport by the kidney, intestinal tract, and bone, mediated by calcaemic hormones especially parathyroid hormone and 1,25-dihydroxyvitamin D3. Abnormalities in calcium transport that result in uncompensated influx into, or efflux from, the extracellular fluid, will result in hypercalcaemia or hypocalcaemia, respectively. When possible the biologically important ionised calcium concentration should be measured. A variety of common disorders are responsible for abnormalities in the serum calcium. Treatment of both hypercalcaemia and hypocalcaemia is dependent on the underlying disorder, the magnitude of the deviation of the serum calcium, and the severity of symptoms. Fortunately, in the case of hypercalcaemia, there is a broad selection of effective medications, especially the bisphosphonates. Treatment of hypocalcaemia relies on the provision of calcium and often vitamin D. In this article we review the mechanisms responsible for abnormalities in calcium homoeostasis, the differential diagnosis of hypercalcaemia and hypocalcaemia, and appropriate therapy.
Matatizo katika mkusanyiko wa kalsiamu katika damu yaweza kuwa na athari kubwa juu ya utendaji wa neva, utumbo, na figo. Utaratibu wa kawaida wa kalsiamu ya seramu ni matokeo ya usafirishaji wa ion uliodhibitiwa kwa ukali na figo, njia ya matumbo, na mifupa, iliyoingiliwa na homoni za kalsiamu, haswa homoni ya parathyroid na 1,25-dihydroxyvitamin D3. Matatizo katika usafirishaji wa kalsiamu ambayo husababisha uingizaji usiofaa katika, au mtiririko kutoka, kioevu cha nje ya seli, itasababisha hypercalcaemia au hypocalcaemia, kwa mtiririko huo. Wakati inawezekana, viwango muhimu vya kalsiamu ionized vinapaswa kupimwa. Matatizo mbalimbali ya kawaida husababisha kasoro za kalsiamu ya damu. Matibabu ya hypercalcemia na hypocalcemia inategemea ugonjwa wa msingi, ukubwa wa kupotoka kwa kalsiamu ya seramu, na ukali wa dalili. Kwa bahati nzuri, katika kesi ya hypercalcaemia, kuna uteuzi mpana wa dawa zenye ufanisi, hasa bisphosphonates. Matibabu ya hypocalcemia hutegemea utoaji wa kalsiamu na mara nyingi vitamini D. Katika makala hii tunakagua utaratibu unaohusika na kasoro katika homeostasis ya kalsiamu, utambuzi wa tofauti wa hypercalcemia na hypocalcemia, na matibabu sahihi.