Tag Archives: Calcium

Barosma betulina

Botanical Name : Barosma betulina
Family: Rutaceae
Genus: Agathosma
Species: A. betulina
Kingdom: Plantae
Order: Sapindales

Synonym: Agathosma betulina, Diosma betulina, Agathosma  crenulata

Common Names: Round leaf buchu , oval leaf buchu

Habitat: Barosma betulina is native to the lower elevation mountains of western South Africa, where it occurs near streams in fynbos habitats.

Description:
Barosma betulina is an evergreen shrub and a flowering plant growing to 2 m tall. The leaves are opposite and of pale green colour, 1/2 to 3/4 inch long, 1/2 inch or less wide, leathery and glossy, with a blunt, strongly-curved tip and finely-toothed margin, with round oil glands scattered through the leaf. Frequently the small white or pae pink flowers, with five petals, and the brownish fruits may be found mixed with the drug. The leaves have a strongly aromatic taste and a peppermint-like odour. ; the fruit is a five-parted capsule which splits open to release the seeds……..click & see the pictures

Edible Use:
Wild plants of this species are still plentiful but are being harvested faster than they can reproduce. The threat of their becoming scarce has led to efforts to cultivate them. The essential oils and extracts of the leaves are used as flavoring for teas, candy, and a liquor known as buchu brandy in South Africa. The two primary chemical constituents of the oils of A. betulina are isomenthone and diosphenol. The extract is said to taste like blackcurrant.

Constituents: The principal constituents of Buchu leaves are volatile oil and mucilage, also diosphenol, which has antiseptic properties, and is considered by some to be the most important constituent of Buchu its absence from the variety known as ‘Long Buchu’ has led to the exclusion of the latter leaves from the British Pharmacopoeia.

Medicinal Uses:
The plant has been used by the indigenous people of South Africa to as a folk remedy for various disorders. Dutch settlers in early times used Agathosma betulina commonly called buchu to make a brandy tincture. The tincture is still used today. In gravel, inflammation and catarrh of the bladder it is specially useful.

The leaves are used locally for antiseptic purposes and to ward off insects.  In western herbalism, the leaves are used for infections of the genito-urinary system, such as cystitis, urethritis and prostates.  Internally used for urinary tract infections (especially prostates and cystitis), digestive problems, gout, rheumatism, coughs, and colds, often combined with Althaea officinalis.  Externally used in traditional African medicine as a powder to deter insects and in a vinegar-based lotion for bruises and sprains.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Resources:
https://en.wikipedia.org/wiki/Agathosma_betulina
http://www.botanical.com/botanical/mgmh/b/buchu-78.html

http://www.herbnet.com/Herb%20Uses_AB.htm

Ficus carica

Botanical Name: Ficus carica
Family:    Moraceae
Tribe:    Ficeae
Genus:    Ficus
Subgenus:Ficus
Species:    F. carica
Kingdom:    Plantae
Order:    Rosales

Common Name : Common fig  or simply  Fig

Habitat: Ficus carica is  native to the Middle East and western Asia, it has been sought out and cultivated since ancient times, and is now widely grown throughout the temperate world, both for its fruit and as an ornamental plant.

Description:
Ficus carica is a gynodioecious (functionally dioecious),deciduous tree or large shrub, growing to a height of  10.00 to 20.00 feet and Spread  10.00 to 20.00 feet with smooth white bark. Its fragrant leaves are 12–25 centimetres (4.7–9.8 in) long and 10–18 centimetres (3.9–7.1 in) across, and deeply lobed with three or five lobes. The complex inflorescence consists of a hollow fleshy structure called the syconium, which is lined with numerous unisexual flowers. The flower itself is not visible outwardly, as it blooms inside the infructescence. Although commonly referred to as a fruit, the fig is actually the infructescence or scion of the tree, known as a false fruit or multiple fruit, in which the flowers and seeds are borne. It is a hollow-ended stem containing many flowers. The small orifice (ostiole) visible on the middle of the fruit is a narrow passage, which allows the specialized fig wasp Blastophaga psenes to enter the fruit and pollinate the flower, whereafter the fruit grows seeds.  Fig pollination and fig fruit.

CLICK & SEE THE PICTURES

Bloom Time: Seasonal bloomer
Bloom Description: Green
Sun: Full sun to part shade
Flower: Insignificant
Fruit: Showy, Edible

The edible fruit consists of the mature syconium containing numerous one-seeded fruits (druplets). The fruit is 3–5 centimetres (1.2–2.0 in) long, with a green skin, sometimes ripening towards purple or brown. Ficus carica has milky sap (laticifer). The sap of the fig’s green parts is an irritant to human skin.

Cultivation:
The common fig is grown for its edible fruit throughout the temperate world. It is also grown as an ornamental tree, and the cultivar ‘Brown Turkey’ has gained the Royal Horticultural Society‘s Award of Garden Merit.

Figs can be found in continental climates with hot summers as far north as Hungary and Moravia, and can be harvested up to four times per year. Thousands of cultivars, most named, have been developed as human migration brought the fig to many places outside its natural range.

Two crops of figs are potentially produced each year. The first or breba crop develops in the spring on last year’s shoot growth. In contrast, the main fig crop develops on the current year’s shoot growth and ripens in the late summer or fall. The main crop is generally superior in both quantity and quality to the breba crop. However, some cultivars produce good breba crops (e.g., ‘Black Mission’, ‘Croisic’, and ‘Ventura’).

There are basically three types of edible figs:
*Persistent (or common) figs have all female flowers that do not need pollination for fruiting; the fruit can develop through parthenocarpic means. This is a popular horticulture fig for home gardeners. Dottato (Kadota), Black Mission, Brown Turkey, Brunswick, and Celeste are some representative cultivars.

*Caducous (or Smyrna) figs require cross pollination by the fig wasp with pollen from caprifigs for the fruit to mature. If not pollinated the immature fruits drop. Some cultivars are Smyrne (Lob Incir in Turkey) – (Calimyrna in the Great Central Valley USA), Marabout, Inchàrio, and Zidi.

*Intermediate (or San Pedro) figs set an unpollinated breba crop, but need pollination for the later main crop. Examples are Lampeira, King, and San Pedro.
The fig likes dry sunny sites, the soil dry or drained. Excessive growth has to be limited to promote the fruiting. It thrives in both sandy and rocky soil. As the sun is really important it is better to avoid shades. Some varieties are more adapted to harsh and wet climates.

Propagation:
Figs plants are easy to propagate through several methods. Propagation using seeds is not the preferred method since vegetative methods exist that are quicker and more reliable, that is, they do not yield the inedible caprifigs. However, those desiring to can plant seeds of dried figs with moist sphagnum moss or other media in a zip lock bag and expect germination in a few weeks to several months. The tiny plants can be transplanted out little by little once the leaves open, and despite the tiny initial size can grow to 1 foot (30 cm) or more within one year from planting seeds.

Edible Uses:
Figs can be eaten fresh or dried, and used in jam-making. Most commercial production is in dried or otherwise processed forms, since the ripe fruit does not transport well, and once picked does not keep well. The widely produced fig newton or fig roll is a biscuit (cookie) with a filling made from figs.

Nutrition value and phytochemicals:
Dried figs are a rich source (> 20% of the Daily Value, DV) of dietary fiber and the essential mineral, manganese, while vitamin K and numerous other minerals are in moderate content (USDA, right table).

Figs contain diverse phytochemicals, including polyphenols such as gallic acid, chlorogenic acid, syringic acid, (+)-catechin, (?)-epicatechin and rutin

Medicinal Uses:
Ficus carica L. (Moraceae), its wide variety of chemical constituents, its use in traditional medicine as remedies for many health problems, and its biological activities. The plant has been used traditionally to treat various ailments such as gastric problems, inflammation, and cancer. Phytochemical studies on the leaves and fruits of the plant have shown that they are rich in phenolics, organic acids, and volatile compounds. However, there is little information on the phytochemicals present in the stem and root. Reports on the biological activities of the plant are mainly on its crude extracts which have been proven to possess many biological activities. Some of the most interesting therapeutic effects include anticancer, hepatoprotective, hypoglycemic, hypolipidemic, and antimicrobial activities. Thus, studies related to identification of the bioactive compounds and correlating them to their biological activities are very useful for further research to explore the potential of F. carica as a source of therapeutic agents.

Figs are used for their mild, laxative action, and are employed in the preparation of laxative confections and syrups, usually with senna and carminatives. It is considered that the laxative property resides in the saccharine juice of the fresh fruit and in the dried fruit is probably due to the indigestible seeds and skin. The three preparations of Fig of the British Pharmacopoeia are Syrup of Figs, a mild laxative, suitable for administration to children; Aromatie Syrup of Figs, Elixir of Figs, or Sweet Essence of Figs, an excellent laxative for children and delicate persons, is compounded of compound tincture of rhubarb, liquid extract of senna, compound spirit of orange, liquid extract of cascara and Syrup of Figs. The Compound Syrup of Figs is a stronger preparation, composed of liquid extract of senna, syrup of rhubarb and Syrup of Figs, and is more suitable for adults.

Figs are demulcent as well as nutritive. Demulcent decoctions are prepared from them and employed in the treatment of catarrhal affections of the nose and throat.

Roasted and split into two portions, the soft pulpy interior of Figs may be applied as emolient poultices to gumboils, dental abscesses and other circumscribed maturating tumours. They were used by Hezekiah as a remedy for boils 2,400 years ago (Isaiah xxxviii. 21).

The milky juice of the freshly-broken stalk of a Fig has been found to remove warts on the body. When applied, a slightly inflamed area appears round the wart, which then shrivels and falls off. The milky juice of the stems and leaves is very acrid and has been used in some countries for raising blisters.

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Resources:
http://en.wikipedia.org/wiki/Common_fig
http://www.missouribotanicalgarden.org/PlantFinder/PlantFinderDetails.aspx?kempercode=c944
http://www.hindawi.com/journals/ecam/2013/974256/
http://www.botanical.com/botanical/mgmh/f/figcom12.html

All about our nails

When we were young, fingernails and toenails gave us no trouble . (They may just be a bit dirty). With advancing age, however, they become brittle, hard, fall off or develop infections and become painful. Suddenly, we are forced to notice our nails!

Looks of nails reveals  many things:
Healthy nails are usually smooth and light pink in colour. Blue nails occur when there is a lack of oxygen in the blood (heart and lung disease). Nails can turn black in vitamin B12 deficiency. A horizontal depression or discoloration can develop across the nail due to illness, antibiotics or chemotherapy. The line becomes prominent as the nail grows out and then gradually disappears. Nails may grow brittle if there is anaemia and can also become spoon shaped. The opposite, a bulged out, parrot-beak like club-shaped nail is seen in chronic obstructive airways disease. Splitting and fraying are associated with hypothyroidism and psoriasis.

Click & see…>Healthy nails

Unhealthy nails

Most important, a close examination of the nails can reveal other disease processes such as iron deficiency (anaemia), vitamin B12 deficiency, diabetes, kidney and liver disease and even infection of the heart valves (endocarditis).

In older people (particularly those who have high blood sugar) an infected ingrown toenail (usually the big toe) is a common problem. This occurs when toenails are trimmed too short, blades or knives are used instead of nail cutters or if the edges of the nails are picked and torn.

Growth of nails:
Fingernails grow faster than toenails. The rate of growth depends on health, heredity and sex. Growth slows during illness and with increasing age, but at the same time, the nails become tougher. They are then more difficult to trim.

Nail biting:
In prehistoric times people had to bite their nails to trim them but today it is a social no-no. Biting in itself is harmless but it can cause secondary bacterial infection of the skin around the nail. It can cause and perpetuate worm infestation. It can transmit flu viruses acquired from contaminated surfaces directly to the mouth. Bitten down nails may work against you in job interviews. It is a habit that is arises out of lack of impulse control, and is perpetuated by stress.

Nail Care:
If there is no diabetes, an ingrown toenail can be treated at home by soaking it in warm salted water for 10 minutes and placing a cotton ball soaked in antibiotic ointment under it.

Nails are also prone to fungal infections. This destroys the nails and gives it an “eaten away” appearance. Topical ointments are not very effective. Medicines have to be taken orally until the infection resolves and a healthy nail grows out. This takes anywhere from three to six months. Medical conditions like psoariasis may mimic fungal infection. A proper diagnosis is essential before embarking on treatment.

For taking care of toe nails, it is advised  to wear slippers or open-toed sandals as in worm climate they  are better than shoes. If shoes have to be worn, they should fit properly. Shoes that people wear every day should have plenty of room around the toes so that nails do not hit the end of the shoe. They should also not be too loose as your feet will slide forward while walking or running and hit the end damaging the nails.It is always adviced to wear socks when one wears shoes.

Resources: The  Telegraph (Kolkata, India)
Diagnose Health Issues by Looking at Your Nails:-

Your fingernails and toenails are not just decorations for the ends of your palms and feet; they’re also an effective warning system for our health. So from now on, before you clip or paint your nails, take a look because they might be trying to tell you something.

WARNING – Some of these images may be unpleasant to look at

1. Dark bands on the nail tips
The tips of the nails seem to have dark bands on each one. This may just be a sign of old age. According to Mayo Clinic, it can also indicate “Terry’s nails“, diabetes, liver disease or even cognitive heart failure. If your doctor diagnoses you as diabetic, you may want to consult with a podiatrist on how to cut your nails to prevent harm.

2. White nails
If your nails are white as seen in the picture,WebMD warns that it may indicate liver problems or hepatitis.

 

3. Clubbed nails
According to the NCBI, nails that are round as seen in the picture may indicate lung problems.

4. Yellow Nails
According to WebMD, if your nails have a yellowish tinge, it may indicate a fungal infection, and even thyroid or lung disease.

5. “Spoon” nails
If the nail edges curve upwards and are soft to the touch, the Mayo Clinic says that it may indicate anemia, heart disease, liver problems, or hypothyroidism.

6. Weak nails
The nails split and chip easily and are overall weak. This often indicates abuse of acrylic nail polish. Let your nails “breath” for a few days, it will help them regain their strength.

7. Bitten nails
WebMD confirms that nails that are bitten down often indicate a state of anxiety, stress, or boredom. Applying foul-tasting nail polish can help you stop chewing on them.

8. Nail dents
If your nails have vertical dents, the NHS says that you may be suffering from skin disorders like eczema or psoriasis, as well as arthritis or even alopecia areata.

9. Loose nails
The nails are loose and come off the nail bed with ease? Cedars-Sinai says that it can indicate hyperthyroidism. If you’re a runner, however, it may just indicate that you’re wearing ill-fitting shoes.

10. Blue nails
Nails that are bluish in color are often an indicator of a lack of oxygen to the extremities. This is why surgeons insist on patients removing any nail polish before undergoing anesthesia. Another possible diagnosis is lung problems, according toWebMD.

11. Ingrown toenails
This is one of the most common nail-related ailments, characterizes by the edges of the toenail growing into the flesh of the toe. This condition may be accompanied by infection and pain.WebMD indicates that the most common causes are: Ill-fitting shoes, trauma to the toe or incorrect trimming of the nails.

12. Dark nails
According to AAFP, if your nails take on a dark color in conjunction with a discoloration of the skin, it may be an indication of melanoma (skin cancer).

13. Nail ridges
Vertical ridges along the nail are actually nothing to worry about.

14. Hematoma under the nail
If you notice spots of red/brown/black color under the nail, it’s most likely indicative of a hematoma, caused by mild trauma to the nail. The AOCDsays that the best treatment is to elevate your feet and ice the injured toe.

15. Horizontal ridges
Horizontal ridges along the nail, known as “Beau’s lines”, occur in cases of zinc deficiency, as well as diabetes, and as a result of high fever. (Source:Mayo Clinic)

16. Thin nails
The AAD warns that constant use of gel nail polish and the subsequent use of UV light and other chemicals can result in thinning of the nails. If this is the case, allow some time for the nails to recover before resuming your gel manicure.

17. Cracked / Missing nails
The NCBI warns that if any part of your nail looks similarly to the discolored, cracked nail in the image on the right, it may indicate that you have a fungal infection called onychomycosis.

18. Pincer nails
According to the NCBI, ill-fitting shoes, excessive trimming, a hereditary condition, and in rare conditions – tumors, can result in the formation of curved “pincer nails”.

19. White spots on the nails
Are there white spots on your nails? WebMD says it’s most likely a result of harsh manicure, nail trauma or ever a hereditary trait.

20. Nail pain
If your nails look healthy but are sore or even painful, visit your doctor and have your nails checked. Pain in the nails can be any of the above reasons, so having them looked at by an expert is not a bad idea.

Source:  E-mail  From of a renowned Doctor

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Calcium Every Day Keeps Fractures Away

Debility, illness and loss of independence are assumed to be an inevitable part of ageing. In  Indian society , where there are no health benefits and minimal social security, old age can be frightening. Unfortunately, young people do not realise that if they take remedial action, some of the incapacitating changes of ageing like osteoporosis are preventable.

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Osteoporosis occurs because of calcium deficiency the bones became fragile and brittle. This means that the slightest trauma can lead to a fracture. In India, the incidence of osteoporosis is high and, with our ageing population, it will only climb.

Patients do not realise that anything is wrong until the first fracture. The trauma that caused the break need not be severe; a trivial fall may be sufficient. The commonest sites are the wrist and the hip. Treatment usually requires setting the bone surgically and screwing it into place. Healing is a long-drawn-out and painful process. Fear of surgery may lead people to native bonesetters, who set fractures with bandages and egg whites. But these ancient treatments are not successful in osteoporosis, especially when the fracture occurs in a deep-seated bone like the hip.

Apart from fractures, early signs of osteoporosis are a decrease in height as the spinal vertebrae grind into each other. This also results in a stooped appearance with a “dowager’s hump”.

The only way to avoid osteoporosis is to have enough calcium, which is necessary not only for healthy bones but also for the proper functioning of cells and enzymes. If there isn’t enough calcium in the blood, the body gets it from the bones. If this calcium is not replaced, the bones become increasingly fragile. Bones are built up in childhood, adolescence and the early twenties. So it should be ensured that the body gets enough calcium during this period. The final strength of the bones is determined by genes but diet and lifestyle can modify this.

The body gets calcium from dairy products such as milk and cheese (processed as well as cottage). Other calcium-rich foods are sardines, custard apples and green leafy vegetables. To absorb dietary calcium, the body also needs 400 IU of vitamin D, 400mg of magnesium and 110 micrograms of vitamin K. The skin can synthesise sufficient vitamin D from sunlight but the problem is that most people either work indoors or use sunscreen and umbrellas. The other source of vitamins is green leafy vegetables. However, the requisite amounts of these vitamins are usually not available in a normal diet. Therefore, you need calcium supplements, most of which contain additional vitamins and minerals to aid absorption.

Calcium supplements are best absorbed if taken after meals in 500mg doses several times a day. Other minerals such as iron and zinc interfere with calcium absorption. Even though many people need supplements of all these elements, they have to be given separately or at least 12 hours apart. A common mistake is to try and combine all these ingredients into one giant biologically ineffective capsule or tablet.

The other thing that can interfere with calcium absorption is too much protein, caffeine (coffee and cola) or alcohol in the diet. There is a demonstrated difference between the bone density of people who drink colas every day and those who drink it once a month.

Osteoporosis can also occur as a side effect of medication like corticosteroids (called secondary osteoporosis). These are prescribed for ailments such as arthritis or asthma and patients are sometimes not aware that they have been given steroids on a long-term basis. Sometimes, it is part of the unlabeled medication dispensed by practitioners of alternative medicine.

Some antacids contain aluminium, which acts as “bone poison” and interferes with the incorporation of calcium into the bones, increasing the risk of osteoporosis. Thyroid disorders or malfunctioning parathyroid glands can also increase the risk of developing the disease. Lactose (milk) intolerance results in an inadequate intake of milk and dairy products with subsequent calcium deficiency.

It is never too late to contain osteoporosis. Physical activity helps bones retain and even gain density all through life. Effective exercises are running, jogging, skipping, stair-climbing, tennis and badminton. Exercise also improves muscle strength and coordination so that falls and injuries are less. One should exercise for an hour every day, all through life. Although exercise at any age is a boon to health, to build bone strength one needs to be regular and consistent.

Daily calcium requirement

• 1-3 yr: 700mg
• 4-8 yr: 1,000mg
• 10-20 yr: 1,300mg
• 20-70 yr: 1,000mg
• Women over 50: 1,200mg
• Men over 71: 1,200mg

Source : The Telegraph ( Kolkata, India)

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Hypercalcaemia

Definition:-

Calcium is a mineral that’s vital for the development of healthy bones and teeth – 99 per cent of the calcium in our bodies is found here. It’s also needed for muscle contraction, regulation of the heartbeat and formation of blood clots. A long-term shortage of calcium can lead to osteoporosis (brittle-bone disease).

The four pea-sized parathyroid glands (found at the front of the neck) are responsible for regulating the body’s calcium levels. These small glands, which are embedded in the tissue of the thyroid gland in the neck, detect fluctuations in the level of calcium in the blood.

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There are times when this delicate balance is upset and too much calcium enters the blood. If levels rise too much, the glands decrease the secretion of the parathyroid hormone (PTH) and calcium levels return to normal again.
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Hypercalcaemia  is an elevated calcium level in the blood. (Normal range: 9–10.5 mg/dL or 2.2–2.6 mmol/L). It can be an asymptomatic laboratory finding, but because an elevated calcium level is often indicative of other diseases, a diagnosis should be undertaken if it persists. It can be due to excessive skeletal calcium release, increased intestinal calcium absorption, or decreased renal calcium excretion.

click to see

Symptoms:
There is a general mnemonic for remembering the effects of hypercalcaemia: “groans (constipation), moans (psychic moans (e.g., fatigue, lethargy, depression)), bones (bone pain, especially if PTH is elevated), stones (kidney stones), and psychiatric overtones (including depression and confusion).”

Other symptoms can include fatigue, anorexia, nausea,abdominal pain, weightloss,loss of appetite, vomiting,constipation, pancreatitis and increased urination.

Abnormal heart rhythms can result, and ECG findings of a short QT interval and a widened T wave suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute myocardial infarction.

Peptic ulcers may also occur.

Symptoms are more common at high calcium blood values (12.0 mg/dL or 3 mmol/l). Severe hypercalcaemia (above 15–16 mg/dL or 3.75–4 mmol/l) is considered a medical emergency: at these levels, coma and cardiac arrest can result.

Causes:-
One of the commonest causes of hypercalcaemia is cancer. Up to 20% of people with cancer have high calcium levels, especially with cancers of the breast, lung, head and neck, and certain blood cancers.

Abnormal parathyroid gland function:
*primary hyperparathyroidism
*solitary parathyroid adenoma
*primary parathyroid hyperplasia
*parathyroid carcinoma
*multiple endocrine neoplasia (MEN)
*familial isolated hyperparathyroidism
*lithium use
*familial hypocalciuric hypercalcaemia/familial benign hypercalcaemia

Malignancy:
*solid tumour with metastasis (e.g. breast cancer or classically squamous cell carcinoma, which can be PTHrP-mediated)
*solid tumour with humoral mediation of hypercalcaemia (e.g. lung cancer [in turn, most commonly of the small cell lung cancer type] or kidney cancer, pheochromocytoma)
*haematologic malignancy (multiple myeloma, lymphoma, leukaemia)

Vitamin-D metabolic disordershyper:
*vitaminosis D (vitamin D intoxication)
*elevated 1,25(OH)2D (see calcitriol under Vitamin D) levels (e.g. sarcoidosis and other granulomatous diseases)
*idiopathic hypercalcaemia of infancy
*rebound hypercalcaemia after rhabdomyolysis

Disorders related to high bone-turnover rateshyperthyroidism:
*prolonged immobilization
*thiazide use
*vitamin A intoxication
*Paget’s disease of the bone
*multiple myeloma

Renal failure
*severe secondary hyperparathyroidism:
*aluminium intoxication
*milk-alkali syndrome

Risk Factors:
An overproduction of PTH may also responsible for hypercalcaemia; this is often caused by a tumour in one or more of the parathyroid glands. Excess production of PTH may occur to compensate for a malfunction in one of the body’s other calcium-balancing mechanisms; for example, when the kidneys aren’t working properly or when there’s a deficiency of vitamin D.

Women over the age of 50 are most likely to have hypercalcemia, usually due to primary hyperparathyroidism.

Diagnosis:
Hypercalcaemia is diagnosed by laboratory tests including: serum calcium, albumin, phosphate, alkaline phosphate, BUN, creatinine, electrolytes and PTH level. These investigations assist in diagnosing the cause of hypercalcaemia and give a baseline indication of renal function. Urinary calcium should be measured as hypercalciuria may be detected. Other investigations may include an ECG and radiology examinations such as x-ray or bone scans which may show bone metastases

Treatment:
The treatment of hypercalcaemia is determined by the underlying disease, the degree of the hypercalcaemia and the patient’s clinical presentation. The aim of treatment is directed at decreasing serum calcium levels by increasing urinary excretion of calcium and decreasing bone resorption of calcium. Immobilization should be avoided as inactivity will cause an increase in bone resorption of calcium. The level of activity will be appropriate for the patient’s physical condition and other measures such as pain control may need to be considered prior to undertaking any physical activities. A review of the patient’s medications will need to be considered. Drugs that inhibit urinary calcium excretion, such as thiazide diuretics, should be ceased. NSAID and H2-receptor drugs, such as Ranitidine which decrease renal blood flow, should also be avoided if possible. Any calcium, Vitamin A and D supplements should also be ceased. Dietary restrictions of calcium have not been proven to be of any benefit to patients that are hypercalcaemic, or at risk of hypercalcaemia. Currently there is no data to suggest that hypercalcaemia has been attributed to food. However, some dietary supplements can cause abnormally hight levels of calcium in the blood. Patients with chronic renal failure are at risk of becoming hypercalacemic due to calcium intake.

This is due to decreased urine production, in combination with high calcium intake). Intravenous fluids (0.9% sodium chloride) will be administered to rehydrate the patient, the volume of fluid given will depend on the extent of the patients dehydration and cardiovascular and renal functions. At least 4-6 litres of saline on day 1, and 3-4 litres for several days thereafter is usual. Diuretics such as frusemide may also be given. Repeat blood tests should be taken several hours after treatment and reassessed. Cardiac status and urinary output should also be assessed, thus a strict fluid balance chart should be maintained on the patient. Oral phosphates, which inhibit bone resorption, may be administered. Diarrhoea is a common side effect and may lead to non-compliance. Bisphosphonates, which are given intravenously, inhibit osteoclast activity that contributes to bone resorption may also be administered. The two most common drugs used are Pamidronate/Aredia (60-90mg IV over 2 hours) and Zoledronic Acid/Zometa (4mg IV over 15 minutes). Both of these agents are generally well tolerated with limited side effects such as mild fever and irritation at the infusion site.

Prognosis:
The prognosis of hypercalcaemia depends upon the cause of increased calcium levels. When the underlying cause is treatable and the treatment is initiated promptly, hypercalcaemia can have a good prognosis. However, when associated with malignancy that has progressed into development of hypercalcemia, prognosis is poor. Hypercalcaemia is potentially fatal. Early diagnosis is important, as the cause of high blood calcium is usually identified and treated to avoid long-term complications. Signs and symptoms may be confused with those of end stage disease in terminal patients. In some patients, symptoms may be non-specific and have a slow onset.Some examples of these are:
•Anorexia
•Weakness
•Nausea
•Vomiting
•Constipation

In other cases, symptoms such as dehydration, renal failure and coma may develop very quickly resulting from very rapidly rising calcium levels. This may result in a life threatening situation. Symptoms do not always correlate with serum calcium levels. These must be closely compared with an in-depth patient history, examination and laboratory report. Signs and symptoms of hypercalcaemia can be numerous and nonspecific. They depend on the underlying cause and how quickly the calcium level rises. Mild hypercalcaemia may be asymptomatic but as the calcium levels rise, the symptoms begin to appear in all body systems. Some non-specific findings associated with hypercalcaemia include: decreased heart rate, hypertension, proximal muscle weakness (chronic hypercalcaemia), bony tenderness, increased tendon reflexes, unwanted tongue movements, dehydration and even coma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/hypercalcaemia1.shtml
http://en.wikipedia.org/wiki/Hypercalcaemia
http://www.virtualmedicalcentre.com/symptoms.asp?sid=31&title=Hypercalcaemia#C3

http://erc.endocrinology-journals.org/content/12/3/549.full

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