Question

how quickly do oral calcium supplements affect calcium levels? how would you treat hypercalcemia?

Answer 1

Before ans1ering your Q, I want to brief you about Calcium metabolism,

Calcium (Ca) is an EXTRA-CELLULAR CATION (positive charged ion).

95-98% of Calcium is stored in BONES and other(2-5%) is CIRCULATING IN BLOOD.

Calcium is richly present in 1) Milk and milk products(maximum), 2) Tofu, 3) Brocooli, cabbage etc

Calcium is absorbed from small intestine under effect of VITAMIN D (fat soluble vitamin)

Parathormone and Calcitonin regulates Calcium level between bone and blood, Parathormone INCREASES blood calcium level (by shifting calcium from bone to blood) , Calcitonin DECREASES blood calcium level (by shifting calcium from blood to bone)

COMING TO YOUR Q

A) How Quickly does oral Calcium supplements affects calcium level?

Calcium supplements comes in 500mg Tablet form, It takes 2 HOURS for calcium to get absorbed from small bowel to blood, so calcium level can rise in as quick as 2-3 hrs, but also depends on gastric emptying time.

B) Treatment of HYPERCALCEMIA

Hypercalcemia is Calcium level more than 2-2.5 mmol/L (8-10mg/dL)

mild hypercalcemia - 2.5-3 mmol/L

moderate hypercalcemia- 3-3.5 mmol/L

Hypercalcemia CRISIS - 3.5-4 mmol/L

Treatment -

Treatment plan is to correct calcium level,make diagnosis of cause followed by treating the cause.

1) Excreting excessive calcium renal route

So to remove excess calcium we used the method of FORCED DIURESIS by giving IV FLUIDS and giving IV DIURETICS drug like FUROSEMIDE.

2) Bisphosphonates drugs like IV PAMIDRONATE / IV ZOKEDRONATE - it acts by inhibiting osteoclastic property in bone and theryby reducing release ofcalcium from bone which will go to blood to increase calcium level more.

3) CALCITONIN - it block extra calcium absorption into bone from blood (usually not used routinely but used in life threatening hypercalcemia)

4) Glucocorticoids - can be used- it enhances Calcium excretion. through kidneys