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1. HypoCalemia
Practical Approach
Mohammed Abdel Gawad
Nephrology Consultant - Alexandria - Egypt
MD Nephrology - Mansoura University - Egypt
European Specialty Examination in Nephrology (ESENeph)
NephroTube Founder/Admin
Member of ISN education SoMe team
Co-chair of AFRAN Web & Media Committee
drgawad@gmail.com
@Gawad_Nephro
NephroTube, 11-August-2021
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drgawad@gmail.com
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5. • Although over 99% of the total body calcium is
located in bone, calcium is a critical cation in
both the extracellular and intracellular spaces.
Plasma (mmol/L) Interstitial fluid
(mmol/L)
Intracellular fluid
(mmol/L)
Na+ 142 144 10
K+ 4 4 160
Ca2+ 2.5 2.5 1.5
Mg2+ 1.0 0.5 13
Cl- 102 114 2
HCO3
- 26 30 8
PO4
2- 1.0 1.0 57
SO4
2- 0.5 0.5 10
6. ECF Calcium
• Extracellular fluid (ECF) calcium is moderately
bound to plasma proteins (46%), primarily
albumin.
• Unbound or ionized calcium is the
physiologically active form and is the fraction
that is homeostatically regulated.
Ca
7. ECF Calcium
• total serum calcium level = includes both
bound + unbound calcium.
• The normal total calcium serum concentration
range is 8.5 to 10.5 mg/dL.
Ca
9. Increase
serum Ca
Increase
serum Pi
Increase Ca
reabsorption
PTH
Increase Pi
excretion
Decrease
serum Pi
M.Gawad. www.nephrotube.blogspot.com
So low serum Ca & high
serum Pi will stimulate
PTH release & vise verca
PTH Action:
increase serum Ca and
decrease serum Pi
10. Increase
serum Ca
Increase
serum Pi
Increase Ca
reabsorption
PTH
Increase Pi
excretion
Vit D
Calcidiol
25-OH-D
Calcitriol
1,25-(OH)2-D
α1 hydroxylase
Increase Ca
& Pi
reabsorption
Decrease
serum Pi
Active vit D
Action:
increase serum Ca & Pi
M.Gawad. www.nephrotube.blogspot.com