Correlation of serum calcium levels with infarct size and severity of stroke using NIHSS score in patients with acute ischemic stroke

Background: Normal cerebral membrane integration is important to maintain the cellular calcium homeostasis. Recent studies have suggested that elevated serum calcium levels at presentation correlates well with the infarct size and severity of stroke.Methods: A total of 73 patients with acute ischemic stroke satisfying inclusion and exclusion criteria were included in the study from November 1st 2017 to April 30th 2019 at a tertiary care centre in Kolar, Karnataka. Serum calcium (total, ionized and albumin corrected calcium) levels were measured at the time of presentation and compared with the infarct size and severity of stroke using NIHSS score (National Institute of Health Stroke Scale).Results: The levels of total calcium, albumin-corrected calcium, and ionized calcium were 9.13±0.89 mg/dL (range: 8.24-10.02), 9.56±0.82 mg/dL (range: 8.74-10.38), and 4.79±0.47 mg/dL (range: 4.3-5.2), respectively. Mean stroke size as measured on the CT scan was 47.38±17.7 cm (range: 21-88). Analysis revealed significant negative correlation between calcium levels (total, corrected, and ionized) and infarct size and severity of stroke.Conclusions: In this study, it was found that there was a statistically significant negative correlation between total, ionized and corrected calcium with the infarct size in patients with ischemic stroke and also the total calcium at presentation and severity of stroke calculated using NIHSS score.

Derivation and Internal Validation of an Equation for Albumin-adjusted Calcium at a Tertiary Hospital in Selangor, Malaysia

@#Introduction: Total calcium concentration is widely used to assess body calcium status although limited by many confounding factors. Thus, this study aimed to derive and internally validate an albumin-adjusted calcium equation for a selected Malaysian population. Method: This cross-sectional study involved 1011 adults at an emergency department of a tertiary hospital. Patients who had total calcium, ionised calcium and albumin measurements taken simultaneously were included. Derivation of the albumin-adjusted calcium equation was based on the adjustment equation obtained from the Association for Clinical Biochemistry and Laboratory Medicine 2015 position paper. Additionally, the equation was internally validated and compared with ionised calcium (gold standard) and the conventional Payne’s equation. Results: The newly derived equation = total calcium + 0.017 (41.35 – albumin). Internal validation exhibited the amount of shrinkage of 0.049. It tends to overestimate the adjusted calcium by a mean difference of 0.029 mmol/L compared to Payne’s equation. The comparison between Payne’s equation and the new equation with ionised calcium reclassified 402 and 486 patients, respectively into different calcium status. When both equations were compared, calcium status classification significantly differed in all and hypoalbuminaemic subjects by 90 and 16 patients, respectively. Conclusion: Locally derived albumin-adjusted calcium equation differed statistically in calcium status classification when compared to the Payne’s equation. However, to confirm this significance, the result must be compared to ionised calcium under strict, controlled preanalytical conditions. In terms of clinical significance, there was no difference in classification of calcium status between Payne’s and the new equation at medical decision limits.

Albumin adjusted calcium: Study in a tertiary care hospital

@#Introduction: One commonly used equation which continues to be widely mentioned in text books and hence familiar to clinical people is total calcium + 0.02 (40 – albumin). This equation was derived using cresophthalein complexone and bromocresol green (BCG) methods for measuring serum total calcium and serum albumin respectively. However this equation maybe invalid when applied to calcium and albumin results generated by alternative assays. Hence we aim to derive an albumin-adjusted calcium equation specific to our laboratory’s total calcium and albumin methodologies. Materials and Methods: A total of 3,175 adult University Malaya Medical Centre (UMMC) patients deemed free of any calcium metabolism disorders were selected and divided into two groups for derivation and validation. Simple linear regression associating total calcium and albumin was constructed from the data in the derivation group. The new albumin-adjusted calcium equation was validated in the validation group. Differences in calcium status classification following adjustments based on existing and new albumin-adjusted calcium equation was compared in a 469 hypoalbuminaemic patients. Result: The new albumin adjusted calcium equation was: total calcium + 0.014 x (39-albumin). Of the 469 hypoalbuminemic patients, 78 were classified differently based on new equation. Based on the new equation, 55 normocalcemic patients were classified as hypocalcemic and 22 were classified as normocalcemic instead of hyperclacaemic. Conclusion: Based on the newly derived albuminadjusted calcium equation 17% of patients had different adjusted calcium classifications. This could potentially impact in the management. It is recommended that laboratories derive equations specific to their calcium/albumin methods and analytical platforms.

Attenuating effect of seeds of Adenanthera pavonina aqueous extract in neuropathic pain in streptozotocin-induced diabetic rats: an evidence of neuroprotective effects

The aim of present study was to investigate the attenuating effects of Adenanthera pavonina L., Leguminosae-Mimosaceae seeds aqueous extract (APSAE), in streptozotocin (STZ)-induced diabetic neuropathy in rats. APSAE (50, 100 and 200 mg/kg per day) was given to diabetic rats for twelve weeks. Cold and hot water tail immersion tests, photoactometer and Rota-rod tests were performed to assess degree of colder, thermal, spontaneous motor activity and motor co-ordination changes respectively at different time intervals i.e., week 0, 4, 8 and 12. Tissue superoxide anion and total calcium levels were determined after twelve weeks to assess biochemical alterations. Histopathological evaluations of sciatic nerve were also performed to assess nerve damage. APSAE treatment increased tail flick latency significantly in diabetic rats. APSAE also reduced superoxide anion and total calcium levels. These results suggested that APSAE has attenuated development of diabetic neuropathy in streptozotocin-induced diabetic rats when compared with pregabalin (10 mg/kg, p.o.) and could be beneficial in preventing the progression of diabetic nephropathy.

Estudio comparativo de la excreción urinaria de boro, calcio, magnesio y fósforo en mujeres posmenopáusicas con y sin osteoporosis / Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis

Con el propósito de comparar la posible relación entre las concentraciones urinarias de boro y las concentraciones de calcio, de magnesio y de fósforo en suero y orina de mujeres posmenopáusicas con y sin osteoporosis, seleccionamos 45 mujeres posmenopáusicas con más de 47 años de edad, divididas en dos subgrupos: grupo I mujeres posmenopáusicas clínicamente sanas y grupo II mujeres posmenopáusicas con osteoporosis, sin enfermedades renales, hepáticas o diabetes mellitus. Se determinó el boro (B), el fósforo (P), el calcio total (Ca) y el magnesio total (Mg) en la orina de dos horas por espectroscopia de emisión atómica con plasma acoplado por inducción (ICPA-ES), el calcio y el magnesio total en suero por espectroscopia de absorción atómica en llama (FAAS) y el fósforo inorgánico en suero y la creatinina en suero y orina por espectroscopia de absorción molecular. Los resultados obtenidos sugieren preliminarmente una diferencia significativa (p<0,05) en las concentraciones de boro y de fósforo en la orina de dos horas entre los grupos estudiados. El análisis de regresión lineal aplicado, sugiere relación entre el índice boro/creatinina y los índices calcio/creatinina, magnesio/creatinina y fósforo/creatinina en la orina de las mujeres posmenopáusicas con osteoporosis.

In order to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis, we selected 45 postmenopausal women over 47 years of age, divided into two groups: group I clinically healthy postmenopausal women and group II postmenopausal women with osteoporosis, without chronic kidney and hepatic diseases or diabetes mellitus. We determined the boron (B), phosphorus (P), total calcium (Ca) and total magnesium (Mg) in the urine of two hours, by atomic emission spectroscopy with induction-coupled plasma (ICPA-ES). Total calcium and total magnesium in serum were determined by atomic flame absorption spectroscopy (FAAS) and inorganic phosphorus in serum, and creatinine in serum and urine, by molecular absorption spectrometry. The preliminary results suggest the existence of a significant difference (p <0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis.

Electrolyte status in birth asphyxia.

Objective. To study electrolyte status in asphyxiated newborns of different severity in early neonatal period and compare with controls. Methods. Sodium, potassium and total calcium levels were estimated in the serum samples of asphyxiated newborns of different severity and control group immediately after birth. Results. Mean serum sodium level was significantly lower (122.1 ± 6.0 mEq/L vs 138.8 ± 2.7 mEq/L; P < 0.001), mean serum potassium was higher (5.05 ± 0.63 mEq/L vs 4.19 ± 0.40 mEq/L; P < 0.001) and mean serum calcium level was found lower (6.85 ± 0.95 mg/dl vs 9.50 ± 0.51 mg/dl; P < 0.001) in cases than controls. Among cases, a strong positive linear correlation was found between the serum sodium, serum calcium levels and their Apgar scores, between sodium levels and total calcium levels and significant negative linear correlation between Apgar scores and serum potassium level. Conclusion. Among cases, hyponatremia and hypocalcemia developed early and simultaneously and the decrease in their serum levels was directly proportional to each other and to the degree of asphyxia. Though, mean potassium level was within the normal limit, the value was higher among cases than controls and directly proportional to asphyxia.

Clinical significance of plasma ionized calcium and total calcium measurement in diagnosis of tumor-associated hypercalcemia / 中国医师进修杂志

Objective To evaluate the clinical significance of plasma ionized calcium (ICa) and total calcium (TCa) measurement in diagnosis of tumor-associated hypercalcemia. Methods The heparin lithium anticoagulated plasma were collected and measured with ion selective electrode (ISE) and orthocresolphthalein complexone (OCPC) method for ICa and TCa in 77 patients with malignant tumor (tumor group) and 44 healthy controls (control group). Meanwhile,plasma albumin and pH value were measured to correct TCa (cTCa) and ICa(nICa). The results were analyzed. Results The levels of cTCa,ICa and nICa in tumor group were significantly higher than those in control group(P＜ 0.01 ) ,but there was no significant difference of TCa between two groups (P ＞ 0.05 ). cTCa ＞ 2.70 mmol/L, nICa ＞ 1.35 mmol/L as the hypercalcemia eritical value, the positive rate of nICa and cTCa were 18.18% (14/77) and 6.49% (5/77)respectively,the difference was significant (P = 0.023). Conclusion Determination of ICa may be more clinical meaningful than TCa for tumor-associated hypercalcemia.

Relationship between Direct Measured and Calculated Ionized Calcium in Maintenance Hemodialysis Patients / 대한신장학회잡지

It is important to maintain normal calcium concentration especially ionized calcium concentration in chronic renal failure patients on hemodialysis. The direct measurement of ionized calcium is less commonly used due to a lack of automated equipment as well as the cost of laboratory equipment. Numerous formulas for adjusted total calcium and calculated ionized calcium are used in clinical practice. We examined the relationship between direct measured ionized calcium and total calcium, corrected total calcium, calculated ionized calcium (formula of Nordin et al) in 53 chronic renal failure patients on hemodialysis. The results were as follows; 1) In predialysis group, plasma total and ionized calcium levels were 2.36+/-0.26, 1.04+/-0.21mmol/L respectively, and higher than normal controls. The correlations between plasma ionized calcium and total calcium, calculated ionized calcium, corrected total calcium were r=0.72 (P=0.0001), r=0.81 (P=0.0001), r=0.65 (P=0.0001) respectively. The plasma ionized calcium level was not correlated with the level of albumin, pH, phosphate, parathyroid hormone. 2) The plasma total and ionized calcium levels were significantly increased with hemodialysis and values were 2.49+/-0.14mmol, 1.14+/-0.14mmol/L respectively. The correlation between ionized and total calcium was r=0.41 (P=0.0021). These results suggested that the calculated ionized calcium (formula of Nordin et al) and total calcium can be used to predict the plasma ionized calcium level in chronic renal patients on hemodialysis.

Effects of different calcium concentration dialysate on calcium balance and iPTH during hemodialysis / 中华肾脏病杂志

Objective To evaluate the acute effects of different calcium concentration dialysate (1.25 mmol/L, 1.5 mmol/L, 1.75 mmol/L) on calcium balance and intact parathyroid hormone(iPTH) in maintenance hemodialysis(MHD) patients with normal serum tCa, and to provide scientific basis for individualized calcium concentration dialysate formula. Methods Dialysate with different calcium concentration (DCa1.25, DCa1.5, DCa1.75) was used in twelve stable MHD patients. Serum tCa, iCa(normalized to pH 7.4) and iPTH were assessed before and after each dialysis session with different calcium concentration dialysate. The iCa from fresh dialysate, spent dialysate at every 30 minutes interval and final total mixed spent dialysate were examined respectively. Phosphorus removal was also determined. Arterial blood pressure(BP) was measured every 30 minutes during hemodialysis session. Results With the DCa1.25, mean calcium loss was 5.03 mmol, but no significant changes of serum iCa and tCa between pre dialysis and post dialysis were found. Serum iPTH increased from (127.17?89.22)pg/ml to (281.92?244.84)pg/ml significantly (P

The quantitative determination of total calcium in normal Thai and nephrotic syndrome patients by direct method.

The determination of serum calcium by direct method is suitable for laboratories because it needs only simple instrument, available in most laboratories. The individual serum calcium was determined by direct method in 60 normal Thais (males = 24, females = 37). The value for male was 8.68 – 11.08 mg/dl in female. There was statistically difference between sexes. In one hundred nephritic syndrome patients (male = 46, female = 54) were ranged from 6.59 – 10.71 mg/dl and 6.52 – 11.08 mg/dl in female. Both were statistically different in the same sex, from the normal value. The nephritic syndrome patient had the lower serum calcium than the normal.