Sample Solution

  Calcium and phosphate are two minerals that play important roles in the body. Calcium is essential for muscle contraction, nerve impulse transmission, blood clotting, hormone secretion and cell membrane permeability. It also helps to maintain bone strength and structure by assisting with

calcium absorption into bones. Phosphate is an important component of nucleic acids, phospholipids, ATP molecules and other high-energy compounds necessary for cellular functions such as energy production and protein synthesis (1). The hormones parathyroid hormone (PTH) and vitamin D regulate the levels of calcium and phosphate in the body. Hypercalcemia occurs when there is an elevated concentration of free serum calcium in the blood due to excessive PTH or vitamin D stimulation or decreased renal excretion of calcium. The pathophysiology of hypercalcemia includes increased intestinal absorption of dietary calcium with subsequent increases in serum ionized calcium concentrations leading to metabolic disturbances such as alkalosis, hypophosphatemia, renal dysfunction and impaired muscular activity (2). Clinical manifestations associated with hypercalcemia vary depending on its severity but can include constipation, nausea/vomiting, abdominal pain/colic, dehydration/polyuria/polydipsia, fatigue/weakness headache dizziness confusion delirium muscle cramps depression coma or death (3). Evaluation should include tests such as comprehensive metabolic panel electrolytes urine analysis urine cultures 25-hydroxyvitamin-D level intact PTH level thyroid stimulating hormone level aortic calcification index 24 hour urinary hydroxyproline excretion test Bence Jones protein measurement etc. Treatment options may include intravenous hydration use of diuretics medications that reduce PTH secretion bisphosphonates glucocorticoids etc (4). Hypocalcemia refers to low levels of free serum calcium occurring due to inadequate intake malabsorption kidney disorders certain drugs surgery gastrointestinal losses pancreatitis adrenal insufficiency liver cirrhosis biliary obstruction or endocrine disorders involving PTH or vitamin D deficiency(5). Pathologically this results in decreased intestinal absorption decreased bone formation impaired nervous system functioning poor neuromuscular function weakened contractions decreased parathyroid gland sensitivity impaired kidney function reduced circulating albumin levels and altered pH management (6). Symptoms may depend on how severe it is but typically involve numbness tingling sensations tetany spasms twitching seizures fatigue irritability abnormal heart rhythms low appetite depression anxiety behavioural changes cognitive impairment etc(7). Evaluation involves obtaining information regarding medical history physical examination laboratory evaluation electrocardiogram imaging studies genetic testing etc. Treatment options can range from diet modification supplementation use of oral antacids corticosteroids which stimulate PTH release calcitonin injection phosphate replacement therapy antibiotics IV fluids bisphosphonates pamidronate injections to surgical removal of enlarged parathyroid glands if required(8). In conclusion both hypercalcemia and hypocalcemia are conditions related to abnormal regulation of serum concentrations by hormones namely PTH or vitamin D which require proper diagnosis evaluation treatment management plan along with lifestyle modifications including dietary restrictions exercise stress reduction enough sleep adequate hydration avoidance risks factors like smoking alcohol consumption along with regular monitoring for overall health maintenance.(9)