My cranium is full of 4 tons of calcium: As such no new Scientific information get an access inside my brain as calcium coating of my skull is protecting me to receive knowledge from all of you!!! Further you members don’t enrich this page by putting Q or posting anything new or even case discussions-at least one Q per week!! This has pained me & have surprised me for last 2 yrs. Pl do put clinical Q in this page so that we can exchange our clinical experiences, wisdom, share our knowledge. Now let us now discuss Calcium metabolism before U proceed for hospital/ N homed rounds.!!
ABC of calcium metabolism:--Calcium & Phosphorus are two friends of film SHOLAY !!!! Calcium along with phosphorus is essential for the formation and development of bones. Normally a healthy adult contains 1 to 1.5 kg of calcium in her /his body . About 99% of total calcium is present in bones and teeth. The total extracellular pool of calcium is about 1 to 1.5 gm ad intracellular pool is about 10-15 gm. Half of total plasma calcium is ionized and present in the biologically active form. About 10% of the plasma calcium is in the non ionized form like calcium bicarbonate and about 40% is bound to albumin. Pl do remember that the pH of blood affects ionization of calcium, In alkalosis ionized calcium concentration decreases and in acidosis it increases. So in dab ketoacidosis never push cal as U do in case of MgSo4 toxicity or massive Blood Tr (citrate toxicity)
Daily intake?? We don’t consume foods by weighing individual components of our meal. Weighing such meal/ snacks at home , element-wise is a mad mans proposal. So how the nutrionists or dieticians have estimated the calcium requirement , Zn content(in male subfertility), Vit D in diet (in osteoporosis) –I wonder ?? There is no answer known to me. You people who purchases ornaments at the cost of Rs 38,000/- per 10 Gm frequently must have a balance machine at your almirah!! Be it that may, estimation of the dietary content (Minimum daily requirement) –of all metals or non-metals is the job of dieticians . Since 1962(when I entered MBBS course) I am reading calcium Metab this but I have always think how & why people calculate calcium content of any diet?? A difficult job indeed!!! Normally healthy adults are in calcium balance that is on average daily intake equals daily loss in urine and feces.
Negative calcium balance –When one needs supplementations?? Except for 1) lactation and pregnancy deviations from balance reflect changes in the metabolism of bone . 2) Immobilization a limb 3) bed rest(ICU-MI, major surgery/ Burns) 4) weightlessness and 5) malignant disease are examples of circumstances that produce negative calcium balance whereas growth of the skeleton produces positive calcium balance.
What is normal Dietary intake of calcium?? Ans. Dietary intake of calcium typically varies between 500 and 1500 mg / day primarily in th form of dairy products,
Can there be overloading if U prescribe calcium for 10 yrs to a postmeno lady hoping that she won’t have fracture: Fracture risk reduction & exogenous cal suppl?? Ans: Anise is No. This is akin to Fe metabolismone way entry excess Fe is not absorbed but in case of cal it is absorbed and excreted in urine, The essential difference between ca & Fe is that Lack or excess of calcium can kill a woman .mean by seconds if given I V If any woman member like to kill a gentleman who is irritating her-my prescription is give him(bad man) who is always after you as Romeo give him Inj calcium 5 Gn after giving him a high dose sleeping pill at your bed room. Police won’t be able to identify the cause of death but excess ca can cause sudden cardiac systole . This is a fact. As I came to know this I refrained from running after young attractive women even they called me at bed room. Let not read my life history of Lord Krishna who is like me used to love 1000000 young women, . Be that as it may, coming to excess calcium in body as long as kidneys are working calcium absorbed from the gut exchanges with the various body pools and ultimately is lost in the urine so that there is no net gain or loss of calcium.
Site of absorption in gut?? Calcium is taken up along the entire length of the small intestine but uptake is greatest in the ileum and jejunum . Net uptake is usually in the range of 100-2000 mg/day . Absorption of calcium occurs by active transport which is regulated by 1,25, vitamin D
A large amount of ca is filtered in the kidneys but 98-8% of the filtered Ca is reabsorbed . About 60% of the absorption occurs in the proximal tubules and the remainder in the ascending limb of the loop of Henley and the distal tubule. Distal tubular reabsorption is regulated by parathyroid hormone. As such in dialysis pts there is abnormalities of cal & PTH as well including Erythropoietin a main haemopoietic factor, So when someone is on dialysis for 4- 6 hrs the technicians do estimate K+, Na+ Ca2 & blood phi
Calcium and vitamin D: Calcium suppl (and possibly Mg suppl too ) prevent PIH. Do U beehive this , my dear members?? Do you prescribe cal routinely to all women anticipating she won’t consume dairy products at her father in Law home ?? Anticipate & Supplement !!!. Her ailing father /mother in law may consume whole milk or curd bought from market and there won’t be any milk / curd left for pregancy daughter in law!!! Members, those who have daughter in law at your home this is the day of confession what do U do. Don’t tell a lie as my grandson does. What do you do?? Phosphorous is one friend an another friend is TV D (??? Insulin sensitizers-your opinion on glucose metabolism and role played by Myoinositol, DCI, Vit D, Vit B 12) ,These are upcoming Q in MRCOG, MD, DNB!!!
Meta analysis of 13 randomized trials comparing at least 1 g daily of calcium during pregnancy with placebo showed a greater than 50% reduction in the risk of pre Eclampsia . The effect was greater for high risk women where the reduction was 80% and for those with low baseline calcium intake.
The world Health Organization recommends calcium 1.5 g to 2 g daily for pregnant women with low dietary calcium intake.
Relevance of Vit D suppl in preg?? Why vit D a sunshine Vitamin where we plenty of sunlight?? Low maternal serum 25 D concentrations increase pre eclampsia risk and vitamin D supplementation lowers this risk.
Recurrence / pre – pregnancy counseling in women who have pre eclampsia in their first pregnancy have about a 15% risk of developing per eclampsia in their second pregnancy
One stitch ingtime9suppl of cal & vit D) saves nine!!! This risk is increased if they have an underlying medical risk factor such as pre existing hypertension CRD or antiphospholipid syndrome. The recurrence risk is also higher in women who had early onset pre eclampsia or HELLP syndrome .Pre eclampsia increases the risk of subsequent hypertension ischemic heart disease and cerebro vascular disease. These risks are also higher with early onset pre eclampsia and FGR
God created women!! Men were created by Devils!!! Now God , as I had a chat yesterday night after consuming 1 ton opium mixed with cannabis , God told me “ Look Srimanta, I am now heavily engaged in creating a new drug which will prevent endothelial dysfunction and another agent which will be tissue friendly cytokines. Don’t worship me now. I feel distracted . U better come to my place later “. . I said “That’s a great idea, my Lord”. HE said “How is your face Book page running??” I said “Me Lord none is contributing in my page , my Lord”, Lord said :” Don’t worry. Give me a list of those members by new reliance Geo phone which has a connection with Monika & Rambha. I shall punish then in 22 nd century
, Don’t worry!!”. At this juncture my wife giver a sudden push to me then asked me : “ To whom U are talking at 4 am ?? Who is that fair Lady,?”” I smiled and again fall asleep.
Atheroma is not the cause of Myo infarction. It is the inflammatory cytokines which provokes endothelial dysfunction resulting into attraction of platelates and thrombus formation. How important is cal suppl & prevention of heart attack?? Pre eclampsia and cardiovascular disease share many of the same risk factors and pathological changes including widespread endothelial damage and dysfunction and an increased systemic inflammatory response . Thus women who have suffered pre eclampsia are candidates for CVD risk screening and possible intervention . Ate
ABC of calcium metabolism:--Calcium & Phosphorus are two friends of film SHOLAY !!!! Calcium along with phosphorus is essential for the formation and development of bones. Normally a healthy adult contains 1 to 1.5 kg of calcium in her /his body . About 99% of total calcium is present in bones and teeth. The total extracellular pool of calcium is about 1 to 1.5 gm ad intracellular pool is about 10-15 gm. Half of total plasma calcium is ionized and present in the biologically active form. About 10% of the plasma calcium is in the non ionized form like calcium bicarbonate and about 40% is bound to albumin. Pl do remember that the pH of blood affects ionization of calcium, In alkalosis ionized calcium concentration decreases and in acidosis it increases. So in dab ketoacidosis never push cal as U do in case of MgSo4 toxicity or massive Blood Tr (citrate toxicity)
Daily intake?? We don’t consume foods by weighing individual components of our meal. Weighing such meal/ snacks at home , element-wise is a mad mans proposal. So how the nutrionists or dieticians have estimated the calcium requirement , Zn content(in male subfertility), Vit D in diet (in osteoporosis) –I wonder ?? There is no answer known to me. You people who purchases ornaments at the cost of Rs 38,000/- per 10 Gm frequently must have a balance machine at your almirah!! Be it that may, estimation of the dietary content (Minimum daily requirement) –of all metals or non-metals is the job of dieticians . Since 1962(when I entered MBBS course) I am reading calcium Metab this but I have always think how & why people calculate calcium content of any diet?? A difficult job indeed!!! Normally healthy adults are in calcium balance that is on average daily intake equals daily loss in urine and feces.
Negative calcium balance –When one needs supplementations?? Except for 1) lactation and pregnancy deviations from balance reflect changes in the metabolism of bone . 2) Immobilization a limb 3) bed rest(ICU-MI, major surgery/ Burns) 4) weightlessness and 5) malignant disease are examples of circumstances that produce negative calcium balance whereas growth of the skeleton produces positive calcium balance.
What is normal Dietary intake of calcium?? Ans. Dietary intake of calcium typically varies between 500 and 1500 mg / day primarily in th form of dairy products,
Can there be overloading if U prescribe calcium for 10 yrs to a postmeno lady hoping that she won’t have fracture: Fracture risk reduction & exogenous cal suppl?? Ans: Anise is No. This is akin to Fe metabolismone way entry excess Fe is not absorbed but in case of cal it is absorbed and excreted in urine, The essential difference between ca & Fe is that Lack or excess of calcium can kill a woman .mean by seconds if given I V If any woman member like to kill a gentleman who is irritating her-my prescription is give him(bad man) who is always after you as Romeo give him Inj calcium 5 Gn after giving him a high dose sleeping pill at your bed room. Police won’t be able to identify the cause of death but excess ca can cause sudden cardiac systole . This is a fact. As I came to know this I refrained from running after young attractive women even they called me at bed room. Let not read my life history of Lord Krishna who is like me used to love 1000000 young women, . Be that as it may, coming to excess calcium in body as long as kidneys are working calcium absorbed from the gut exchanges with the various body pools and ultimately is lost in the urine so that there is no net gain or loss of calcium.
Site of absorption in gut?? Calcium is taken up along the entire length of the small intestine but uptake is greatest in the ileum and jejunum . Net uptake is usually in the range of 100-2000 mg/day . Absorption of calcium occurs by active transport which is regulated by 1,25, vitamin D
A large amount of ca is filtered in the kidneys but 98-8% of the filtered Ca is reabsorbed . About 60% of the absorption occurs in the proximal tubules and the remainder in the ascending limb of the loop of Henley and the distal tubule. Distal tubular reabsorption is regulated by parathyroid hormone. As such in dialysis pts there is abnormalities of cal & PTH as well including Erythropoietin a main haemopoietic factor, So when someone is on dialysis for 4- 6 hrs the technicians do estimate K+, Na+ Ca2 & blood phi
Calcium and vitamin D: Calcium suppl (and possibly Mg suppl too ) prevent PIH. Do U beehive this , my dear members?? Do you prescribe cal routinely to all women anticipating she won’t consume dairy products at her father in Law home ?? Anticipate & Supplement !!!. Her ailing father /mother in law may consume whole milk or curd bought from market and there won’t be any milk / curd left for pregancy daughter in law!!! Members, those who have daughter in law at your home this is the day of confession what do U do. Don’t tell a lie as my grandson does. What do you do?? Phosphorous is one friend an another friend is TV D (??? Insulin sensitizers-your opinion on glucose metabolism and role played by Myoinositol, DCI, Vit D, Vit B 12) ,These are upcoming Q in MRCOG, MD, DNB!!!
Meta analysis of 13 randomized trials comparing at least 1 g daily of calcium during pregnancy with placebo showed a greater than 50% reduction in the risk of pre Eclampsia . The effect was greater for high risk women where the reduction was 80% and for those with low baseline calcium intake.
The world Health Organization recommends calcium 1.5 g to 2 g daily for pregnant women with low dietary calcium intake.
Relevance of Vit D suppl in preg?? Why vit D a sunshine Vitamin where we plenty of sunlight?? Low maternal serum 25 D concentrations increase pre eclampsia risk and vitamin D supplementation lowers this risk.
Recurrence / pre – pregnancy counseling in women who have pre eclampsia in their first pregnancy have about a 15% risk of developing per eclampsia in their second pregnancy
One stitch ingtime9suppl of cal & vit D) saves nine!!! This risk is increased if they have an underlying medical risk factor such as pre existing hypertension CRD or antiphospholipid syndrome. The recurrence risk is also higher in women who had early onset pre eclampsia or HELLP syndrome .Pre eclampsia increases the risk of subsequent hypertension ischemic heart disease and cerebro vascular disease. These risks are also higher with early onset pre eclampsia and FGR
God created women!! Men were created by Devils!!! Now God , as I had a chat yesterday night after consuming 1 ton opium mixed with cannabis , God told me “ Look Srimanta, I am now heavily engaged in creating a new drug which will prevent endothelial dysfunction and another agent which will be tissue friendly cytokines. Don’t worship me now. I feel distracted . U better come to my place later “. . I said “That’s a great idea, my Lord”. HE said “How is your face Book page running??” I said “Me Lord none is contributing in my page , my Lord”, Lord said :” Don’t worry. Give me a list of those members by new reliance Geo phone which has a connection with Monika & Rambha. I shall punish then in 22 nd century
, Don’t worry!!”. At this juncture my wife giver a sudden push to me then asked me : “ To whom U are talking at 4 am ?? Who is that fair Lady,?”” I smiled and again fall asleep.
Atheroma is not the cause of Myo infarction. It is the inflammatory cytokines which provokes endothelial dysfunction resulting into attraction of platelates and thrombus formation. How important is cal suppl & prevention of heart attack?? Pre eclampsia and cardiovascular disease share many of the same risk factors and pathological changes including widespread endothelial damage and dysfunction and an increased systemic inflammatory response . Thus women who have suffered pre eclampsia are candidates for CVD risk screening and possible intervention . Ate
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