49 Calcium, Total Clin Lab Navigator.Com


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49 Calcium, Total Clin Lab Navigator.Com

  1. 1. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Calcium, Total C1 Esterase Inhibitor C Reactive Protein C Reactive Protein High Sensitivity Plasma calcium exists in the blood in three forms; 50% is ionized, 40-45% is protein bound, CA 125 and 5-10% is complexed to anions such as bicarbonate, citrate, sulfate, phosphate, and CA 153 lactate. Plasma ionized calcium is the biologically active moiety. Total calcium levels are CA 19.9 maintained between 8.8 and 10.2 mg/dL. Parathyroid hormone and vitamin D regulate normal CA 27.29 plasma calcium levels by their actions on kidney, intestine, and bone ion transport. Caffeine Calcitonin Protein Evolution Detoxamin Calcium Superior to Directed Evolution Next Generation the safe, gentle & proven chelation therapy Calcium Ionized Technologies alternative Carbamazepine www bioatla com www detoxamin com Carbon Dioxide Carbon Monoxide Carcinoembryonic Antigen Carcinoid Syndrome The main causes of hypercalcemia are primary hyperparathyroidism, malignant disease, and Cardiac Marker Panel chronic renal failure. The differential diagnosis of hypercalcemia depends on the clinical setting. Cardiovascular Risk Panel Overall, primary hyperparathyroidism and malignancy account for 80 - 90% of hypercalcemia Carotene cases. However, primary hyperparathyroidism is the cause of ~60% of ambulatory cases and CCP Antibody of ~25% of inpatient cases, whereas malignancy causes ~35% of ambulatory cases and 65% CD4 Enumeration of inpatient cases. Celiac Disease Panel Centromere Antibody Malignancies can raise serum calcium levels by either direct bone destruction or secretion of Cephalothin Antibody calcemic factors. Patients with squamous cell carcinoma of the lung, metastatic breast cancer, Cerebrospinal Fluid multiple myeloma, and renal cell carcinoma are most prone to hypercalcemia. These tumors Ceruloplasmin may produce PTH related protein (PTH-rp) which binds to PTH receptors, but is not detected by Chemistry Panels standard intact PTH immunoassays. Specific assays for PTH-rp are available. Chlamydia Detection Chloride The prevalence of hyperparathyroidism in the general population is 1 to 2 cases per 1000 Cholesterol people, but is more frequent in the elderly and in women. The most common pathological Cholinesterase lesion is a single parathyroid adenoma (85% of cases) or chief cell hyperplasia (10%). Clindamycin Resistance Parathyroid carcinoma occurs in 1 to 3% of cases. Hyperparathyroidism also occurs in multiple Clostridium Difficile endocrine neoplasia type 1 and 2A. Patients identified by laboratory screening are commonly Coagulation Factor Assays asymptomatic. Presentation with kidney stones is unusual today, but 5% of patients with Coagulation Factor Inhibitor kidney stone disease have primary hyperparathyroidism. Finding an elevated PTH level in a Coagulation Screen patient with hypercalcemia makes the diagnosis. Cold Agglutinin Titer Colloid Osmotic Pressure The signs and symptoms of hypercalcemia are summarized in the following table. Complement Profile Complete Blood Count Mental Neurological & Skeletal GI & Urological Congenital Adrenal Hyperplasia Cord Blood Gases Cord Blood Studies Fatigue Reduced muscle tone Nausea Corticotropin Releasing Hormone Stimulation Test Obtundation Muscle weakness Vomiting Cortisol Cortisol in Critical Illness Cortisol Salivary Apathy Myalgia Polyuria Cortisol Urine Free Cortrosyn Stimulation Test Lethargy Pain Polydipsia Cotinine Creatine Kinase Confusion Deep tendon reflexes Dehydration Creatine Kinase MB Creatinine Creatinine Clearance Disorientation Anorexia Creatinine Kinase Isoenzymes Crossmatch Coma Constipation CRP Cryoglobulin Cryptococcal Antigen Cryptosporidium Antigen Evaluation of hypercalcemia usually begins with measurement of total calcium. If total calcium Crystal Identification is markedly elevated, an ionized calcium level is usually not needed. Slightly to moderately Cushing Syndrome elevated total calcium should be confirmed by measurement of ionized calcium. The patient's Cyclosporine history may indicate the cause, such as; immobilization for more than a week, drug therapy, Cystic Fibrosis hyperthyroidism, adrenal insufficiency, or familial hypocalciuric hypercalcemia. If time permits, Cytogenetic Studies
  2. 2. total calcium levels should be repeated two more times to rule out a transient cause of Cytomegalovirus Antibody hypercalcemia before undertaking a complete work-up. If hypercalcemia is still evident, serum Cytomegalovirus Culture albumin and total protein should be determined. Calcium levels should be corrected for Cytomegalovirus PCR Qualitative elevated albumin levels (see below). If total protein is high, but albumin is normal or low, a Cytomegalovirus PCR Quantitative monoclonal gammopathy should be ruled out by serum protein electrophoresis. Serum chloride, phosphorus and intact PTH are also useful in diagnosing the most frequent causes of hypercalcemia; malignancy and hyperparathyroidism. Serum chloride is mildly elevated in primary hyperparathyroidism. Renal Epithelials - Normal Test Hyperparathyroidism Malignancy ATCC Primary Cell Solutionsâ„¢ LGC Total calcium (mg/dL) <12.4 >12.4 Standards partnered with ATCC Chloride (meq/L) >103 <103 www.lgcstandards-atcc.org Phosphorus normal to low normal Cytokine Center Chloride : phosphorus ratio 29 or greater <29 Recombinant cytokines, ELISPOT Kits ELISA Intact PTH elevated suppressed Kits, related antibodies www.cellsciences.com PTH-rp normal elevated Calcitriol elevated low Calcium carbonate Ground calcium carbonate (GCC) fillers & Hypocalcemia most commonly results from PTH deficiency or failure to produce 1,25 dihydroxy extenders...CaCO3 vitamin D. The most common causes of hypoparathyroidism are parathyroid or thyroid surgery www.imerys-perfmins.com/ and parathyroid infiltration by cancer, sarcoid, amyloid or hemochromatosis. Acute illnesses such as pancreatitis, hepatic failure, sepsis, and various medications can also cause hypocalcemia. The normal response to a fall in the plasma ionized calcium level is increased PTH secretion and 1,25 dihyroxy vitamin D synthesis, leading to increased calcium absorption New Diabetes 2 from the intestine and increased resorption from bone and kidneys. Treatment First European stem cell Some drugs are associated with hypocalcemia. Gentamicin and cisplatin cause renal clinic treats your diabetes magnesium loss, which leads to hypocalcemia. Heparin therapy releases fatty acids that bind calcium ions and cause transient hypocalcemia. Anticonvulsants such as dilantin and now! phenobarbital induce the microsomal oxidase pathway which accelerates inactivation of vitamin www.xcell-center.com/Diabetes D. Loop diuretics such as furosemide enhance renal calcium excretion. Phosphate salts bind up calcium ions causing hypocalcemia. Protein Evolution The laboratory evaluation of a low total plasma calcium level should include measurement of Superior to Directed ionized calcium, magnesium, and phosphorus levels. Low ionized calcium rules out artefactual causes of hypocalcemia, such as hypoalbuminemia. Abnormally high or low magnesium levels Evolution Next should be excluded because they can inhibit PTH secretion. A low serum phosphorus level is Generation Technologies consistent with vitamin D deficiency, while a high level suggests chronic renal failure or www.bioatla.com pseudohypoparathyroidism. Measurement of intact PTH levels helps to differentiate between conditions caused by PTH and vitamin D defects. The demonstration of an inappropriately low intact PTH level in the presence of hypocalcemia is consistent with the diagnosis of hypoparathyroidism. Serum 25-hydroxyvitamin D levels can be measured to confirm vitamin D deficiency. Total calcium levels are effected by changes in plasma protein concentrations. Most of the protein bound fraction of calcium is bound to albumin; each 1 g/dL of albumin binds 0.8 mg/dL of calcium. Three formulas have been used to correct calcium for decreased serum albumin levels: %Calcium bound = 8 (albumin) + 2(globulin) + 3 Corrected calcium = measured Calcium /0.6 + [total protein/8.5] Corrected calcium = Calcium - albumin + 4 Each formula will give a slightly different value for corrected calcium. A better approach is to directly measure ionized calcium levels. Two of the four approved gadolinium based magnetic resonance (MR) imaging contrast agents, gadodiamide (Omniscan) and gadoversetamide (OptiMARK), have recently been shown to interfere with calcium measurements on some chemistry analyzers, resulting in falsely low values. Patients with normal renal function may have spuriously low calcium measurements up to 24 hours after administration of these contrast agents, but patients with renal insufficiency may be affected for up to 4.5 days. However, the Vitros chemistry analyzers used throughout the Saint Luke's Health System are not adversely affected (Am J Clin Pathol 2004;121:282- 92). Reference range is 8.8 - 10.2 mg/dL. Calcium levels less than 6.0 mg/dL or greater than 13.0 mg/dL are considered critical values.
  3. 3. Specimen requirement is one SST tube or one green top (heparin) tube of blood. Prolonged venous stasis should be avoided because it can produce artefactual hypercalcemia. Diagnostic for Sepsis Protein Evolution Detoxamin Development of genetic test to Superior to Directed Evolution Next the safe, gentle & proven chelation determine response to Protein C Generation Technologies therapy alternative www.siriusgenomics.com www.bioatla.com www.detoxamin.com Advertise | Biography | Terms of Use | Privacy Policy | Site Map | Copyright © 2006 - 2009 by ClinLab Navigator, LLC.