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Calcium phosphate and magnesium balance in patients with acute illness

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Critical Care Nephrology

Abstract

Calcium is an essential divalent cation involved in many biological functions, such as the structural support of the body, neuromuscular and cardiovascular functions, blood coagulation, intracellular signal transmission and enzymatic reactions. There are about 1.3 kg of calcium in a normal 70 kg adult, approximately 99% of which is present in bones and teeth, 1% in soft tissue cells and 0.1% in extracellular fluid (ECF). The normal concentration of total plasma calcium is 8.4–10.4 mg/dl. Total plasma calcium exists in two forms: a protein-bound (predominantly albumin-bound) fraction, accounting for about 40% and a non protein-bound or ultrafilterable fraction, accounting for about 60% of the total plasma calcium. About 90% of the ultrafilterable calcium is in ionized form, the only homeostatically controlled and physiologically active form of plasma calcium; the remaining 10% is chelated to various anions including bicarbonate, citrate and phosphate. Changes in plasma albumin concentration must be considered in the interpretation of total plasma calcium concentration: in general, for each 1 g/dl decrease (or increase) in plasma albumin, there is a decrease (or increase) of about 0.8–1 mg/dl in total plasma calcium. The calcium binding properties of plasma albumin are affected by blood pH. Consequently plasma levels of ionized calcium (Ca2+) may change, even if there are no alterations in total plasma concentration (and vice versa). Alkalosis increases the binding of calcium to albumin and thereby reduces plasma Ca2+ concentrations, whereas the Ca2+ concentration increases in the presence of acidosis. The changes in Ca2+ levels induced by pH are usually small [1], but their clinical implications are considerable.

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Authors
  1. Giuseppe Pontoriero
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  2. Francesco Locatelli
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  3. Eberhard Ritz
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© 1998 Springer Science+Business Media Dordrecht

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Pontoriero, G., Locatelli, F., Ritz, E. (1998). Calcium phosphate and magnesium balance in patients with acute illness. In: Critical Care Nephrology. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5482-6_19

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  • DOI: https://doi.org/10.1007/978-94-011-5482-6_19

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6306-7

  • Online ISBN: 978-94-011-5482-6

  • eBook Packages: Springer Book Archive

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