KNOW YOUR CALCIUM IRREGULARITIES- DUE TO DISEASES-1

HIGH CALCIUM-PAGET'S DISEASE

                                

Calcium is an important mineral in regulating many physiological activities in our body system.

If the serum calcium level is above the normal range (8 to 10mg/dl or 2 to 2.5 mmol/L) the condition is known as Hypercalcemia
In this article, we are mainly going to see hypercalcemia due to Paget's disease.
Serum calcium level is raised alarmingly due to many causes such as over consumptions of calcium supplementations and comorbidities such as milk-alkali syndrome, overactivity of the parathyroid gland, use of certain drugs like thiazide diuretics, an oversupply of vitamin A and D.etc, etc.
But there are certain cancers such as cancerous neoplasms, Paget's Bone Disease, Addison's Disease, Zollinger-Ellison's syndrome, and Sarcoids can also raise serum calcium level alarmingly as a cancer marker.

1.Paget's Bone Lesions:-

This is a condition in which the normal bone tissue recycling process by the body is modified and the bone become fragile with painful lesions.

Paget's disease mostly occurs at the skull, pelvis, spine, breast, and legs.

The common sign is the formation of oozing eczema-like lesions with scaly skins at the site. If it is at the breast the nipple skin becomes hardened and scaly.

The doctor can diagnose if the above symptoms persist with x-ray alone or with blood tests and bone scans.

A blood test at the beginning will show the raising level of an enzyme known as Serum Alkaline Phosphate (SAP).SAP is normally produced by the bone cells to wear out the old bone cells to be replaced by new cells without affecting the serum calcium level.

But in diseased bones the cells double their production of SAP and the formation of new bone cells (bone sorption or formation) is overwhelmed by bone resorption or deformation and the malignant condition is known as Paget's disease.

At the beginning of the disease the calcium levels may be normal but in due course of time the calcium level becomes alarmingly raise due to severe and uncontrolled bone resorption. Some times the body uses the old bones to form abnormal new bones without using serum calcium.

Hence in blood test high levels of SAP are the indicator marker for Paget's disease.

The symptoms are very similar to arthritis and usually occur as joint pain, redness of the skin, swelling, and tenderness of the skin.
Paget's disease differs from osteoporosis, that in osteoporosis the bone becomes weakened by decreased bone mass and skeletal architecture due to focussed bone resorption, and the serum calcium level rises.
In Paget's disease the body absorbs old bones to remodel and form irregular bones without using serum calcium and phosphate.
Paget's disease may cause several complications including cancer as follows:-
1.Hearing Loss
2.Arthritis
3. Cardiac or heart problems
4.Nerve problems
5. Sarcoma but the possibility is 1 in 100
6.Tooth Problem
7.Vision problems

Causes

Doctors believe that a measles attack at the childhood age may cause Paget's disease later on.

Treatments

Treatments can control the progression of the disease but will not bring a full cure.

Bisphosphonates such as Etidronate and Pamidronate can be the drugs along with aggressive intake of Calcium and vitamin D

Etidronate can be given either by oral or IV route 

Pamidronate is the drug of choice for those who prefer the IV routes.

It is recommended for the age between 50 to 70 years 1000mg of calcium and 700 units of vitamin D per day should be given while taking bisphosphonates provided that hypercalcemia and hyperparathyroidism are ruled out.

For the age group above 70 years vitamin D should be given at the rate of 800 units per day.

Bisphosphonates and calcium should be given with a time interval of at least two hours as calcium may interfere with the absorption of oral bisphosphonates.
In both, the above cases calcium and phosphorous should be administered if the condition is not associated with hypercalcemia and hyperparathyroidism.

Bisphosphonates can inhibit the bone resorption process by reducing the functions of osteoclasts and the formation of hydroxyapatite crystals in remodeling the bones.
Also bisphosphonates reduce the reabsorption of calcium and phosphates by the kidneys and increase their excretion.

Side Effects:-

1. Pain in the pagetic lesions is often experienced

2.Nephrotoxicity (Kidney Failure)

There are other drugs such as calcitonin, gallium nitrate plicamycin that can also be used to treat hypercalcemia associated with Paget's Disease.

KNOW YOUR LOW SODIUM-HYPONATREMIA

LOW SODIUM

Sodium-Ion

Sodium is a light weighted metal. It is a strong basic metal and is present abundantly in our body fluids as a sodium ion.
It is a monovalent ion that can able to form a single electrovalent bond with a negatively charged monovalent ion such as chloride or bicarbonate ion.
In our body sodium is present in the extracellular fluids.
 The normal blood sodium level is 130 to 140 Milli Equivalents per liter. If the blood sodium level goes below 120 Milli Equivalents the condition is known as Hyponatremia
Sodium helps cells to be activated. Low sodium cause the following symptoms:-
1.Tiredness, Vertigo, and Giddiness
2.Nausea and Vomiting
3.Headache due to the osmotic effects in between the brain cells.
Due to low sodium in the intercellular fluids, and hypotonicity more solvent is drawn into the cells which may become bulged and ruptured and damaged.
Due to brain and nerve cell damage, one can experience along with headache, confusion, loss of energy, drowsiness, and fatigue.
4. Restlessness and irritability.
5.Muscle weakness and cramps.
6. Damaged cells cause seizures and coma.

Causes:-

Generally sodium is needed by our body to maintain normal body fluid balance, normal blood pressure, and to support the activities of nerves and muscles.

The following medications and lifestyle changes cause low sodium in our body:-

1. Long time use of diuretics (thiazide, loop diuretics), antidepressants, pain killers may cause low sodium.

2. Congestive heart failure and liver failure may cause more fluid accumulation in our body and can dilute sodium levels. 

3 High Anti-Diuretic Hormone (SHAH). High-level secretion of Vasopressin an antidiuretic hormone from the posterior pituitary may cause more ion free water to be reabsorbed by the kidney which dilutes blood sodium.

4. Dehydration due to severe chronic diarrhea, vomiting, and summer weather may cause sodium loss.

5. Drinking more water also may cause low sodium due to the dilution of body sodium ion.

6.Hormonal Disturbances, such as insufficient adrenal gland activity (Addison's Disease), in which there are insufficient secretions of adrenal hormones such as aldosterone to maintain normal mineral balances 

7. Low thyroid activity also can cause low sodium

8. Drug abuses such as amphetamine can cause a dangerous low sodium level.

Diagnosis

1.Blood Tests

2.Urine Tests

Treatments

1. If you are under medications such as diuretics and fluid intake then your doctor will advise you to adjust the diuretic dosage and cut back the fluid intake.

2.IV infusions of sodium fluids. Mostly a half normal saline (0.45% sodium chloride) can be used to raise the sodium level slowly in chronic hyponatremia.

The slow raising of sodium is very important as the rapid raising of sodium may cause brain damage.

3. To treat acute hyponatremia 

4. If a person can tolerate oral fluids he can drink saltwater or any salt preparation if there is no emergency.

5. Symptoms such as headaches, nausea, and vomiting can be treated with appropriate medicines

Cancer Marker

The following cancer incidence can be predicted by the low sodium from the time when it is diagnosed six months to one year time is for the occurrence of the following cancers.

1.Lungs

2.Liver

3.Brain

4.Pancreas

5.Kidney

6.Esophagus

7.Pharynx

8.Non-Hodkin lymphoma

MINERAL IMBALANCES-2-HYPOKALEMIA-LOW LEVEL POTASSIUM

2.HYPOKALEMIA-LOW POTASSIUM

              In this article we study the effects of low-level potassium in our body.

As we know that potassium is an inhibitory ion if its level becomes low in our body then naturally the excitatory effects of other ions such as sodium and calcium may predominate but that is not always the case in practice.

If the blood level of potassium is below 3 million mol per liter then it is said to be low-level potassium or Hypokalemia.

Junk foods such as processed fast foods are low in potassium. People who diet more with processed food only as their daily routine diet may likely to get potassium deficiency.

While taking fresh fruit we must ensure maximum to consume the whole fruit unpeeled. Most of the green vegetables and fruits are enriched with potassium on their skin.

Lake of potassium in our blood may lead to many complications such as cardiac fibrillation including both atrial and ventricular, which is due to uncontrolled heartbeats tachycardia and arrhythmias may follow.

Potassium is controlling healthy muscle contracts, healthy nerve functions, and regulating fluid imbalances.

Low-level potassium will affect almost all body organs and their functions including heart, liver, kidney, and lungs.

Symptoms:

1. Fatigue and dullness, these are the first signs of potassium deficiency. Because potassium maintains muscle contraction and low-level potassium may lead to weaker muscle contractions such as the muscles of the heart, lungs, and kidney. Weak heart contractions produce low blood circulations, low insulin production etc.etc.which leads to weakness and fatigue.

2.uncontrolled muscle contracts may lead to sudden muscle cramps.

3.Constipation and bloating because low potassium causes uncontrolled weak muscular contracts in the digestive system. Hence food movements inside the alimentary canal are very slow or almost nill.

4. Irregular and weak heart contractility leads to palpitations.

5.Muscle weakness and cramps

6.Tingling and numbness of the muscle. This condition is known as Paresthesia which usually occurs in fingers, legs, and arms.

7. Severe potassium deficiency may cause respiratory depression because of the weakened muscle contractions of the lungs.

8. Low potassium levels may also cause serious mental and mood swings.
9. The most important is potassium deficiency can cause more insulin secretions (Hyperinsulinemia)and serious hypoglycemic episodes.

Diagnosis:-

1.Urine Tests:-As a general theory sodium and potassium are competitive to each other in reabsorption and excretion. That means if more sodium is reabsorbed by the body then more potassium is excreted out and vice versa.

These games are controlled by aldosterone from the adrenal cortex and thiazide diuretics at Distal Convoluted Tubules (DCT) and loop diuretics(Lasix) at the Ascending Loop of Henle (ALH) of the nephron.

Aldosterone is the hormone secreted from the adrenal cortex, the only mineralocorticoid from our body plays a role in reabsorbing sodium with the excretion of a little potassium (2%) at the DCT.

Hence if more aldosterone secreted that means more potassium will be wasted out. In other words Hyperaldosteronism may also be a cause for potassium depletion from our body.

In urine usually if the sodium level is lower than 16 mEq/L then there is a high level of potassium is excreted out due to secondary hyperaldosteronism.

Urinary potassium assessments can be made from a 24 urine collection. The normal potassium excretion should not exceed 25 to 30 mEq of potassium per day. This an accurate method. If this method is not possible then follow the spot urine test involving the ratio of potassium to creatinine can be done as an alternate. In this method, if the ratio of potassium to creatinine is greater than 12 mEq/g creatinine (1.5 mmol) then there is an apparent loss of potassium 

2. Random Urine Potassium Concentration Tests can also be used. In this test the measured results should show a figure above 15 mEq of potassium per liter.

3.Tests of Acid-Base Balances:-

After the urine diagnosis the patients of uncertain origin can be subjected to these tests for confirmations.

Diarrhea due to G.I distress or laxative abuses may lead to loss of potassium.

Metabolic acidosis or alkalosis is common during diarrhea, diuresis, or vomiting.

Metabolic acidosis means the blood is more acidic due to heavy loss of alkaline ions such as sodium or potassium and more secretion of acidic ions such as bicarbonate and chloride with hydrogen ions.

On the contrary alkalosis is the vice versa. But in both cases there may be potassium loss due to sodium, and bicarbonate reabsorption.

Treatments:-

Treatments should be based on the etiology of the condition.

Hypokalemia is of two types

The real hypokalemia is due to the actual loss of potassium due to diarrhea vomiting, diuresis by the loop, and thiazide diuretics or aldosterone hyperactivity.

In severe depletion a potassium infusion may be helpful. Otherwise potassium supplements are prescribed by the doctor.
Foods enriched with potassium such as unpeeled vegetables and fruits, potato, sweet potato etc.etc.

The other type is pseudo-hypokalemia in which even though there is no potassium loss but the blood potassium level is lower due to high potassium redistribution within the body cells as in the case of hyperthyroidism, hypocalcemia, hypomagnesemia, and hyperinsulinemia.
In these cases the respective corrective treatments should be given.

Potassium Supplements:-

1.Potassium Gluconate

2.Potassium Iodide

3.Potassium Citrate

4.Magnesium and Potassium Supplements

 In all the above preparations potassium is supplied per dose not to exceed 100 mg for safety.