CALCIUM – Hyper & Hypokalemia

Our body needs calcium predominantly for strong bones and teeth. A small ionized pool of calcium in the circulatory system, extracellular fluid, and various tissues mediates blood vessel contraction and dilation, muscle function, blood clotting, nerve transmission, and hormonal secretion.

What is the recommended daily dietary calcium intake?

Healthy teenagers and adults over the age of 10 years should have 1000 – 1200 mgs of calcium everyday. Infants from 0-6 months should have a daily intake of 200 mgs and 7-12 months should have 260 mgs of calcium daily. Children from age 1 to 3 years should have 700 mgs of calcium daily. 

What are the sources of dietary calcium?

Milk, yogurt, and cheese are rich natural sources of calcium. In the United States, approximately 72% of calcium intake comes from dairy products and foods with added dairy ingredients. Non-dairy sources include canned sardines and salmon with bones as well as certain vegetables, such as kale, broccoli, and Chinese cabbage (Bok choi).

The absorption of calcium from dairy products and fortified foods is about 30%. Net absorption of dietary calcium is reduced to a small extent by intakes of caffeine and phosphorus and to a greater extent by low status of vitamin D. Calcium absorption is only 5% for foods with high levels of oxalic acid that include spinach, collard greens, sweet potatoes, rhubarb, and beans. (https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/#h3) 

Who are at risk of having calcium deficiency?

People who:

• Follow a vegan diet
• Have lactose intolerance and limit dairy products
• Consume large amounts of protein or sodium, which can cause your body to excrete more calcium
• Are receiving long-term treatment with corticosteroids
• Have certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease or celiac disease.
• Drinking too much caffeine or alcohol
• Have removed thyroid (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/calcium-supplements/art-20047097) 

What are the symptoms of calcium deficiency?

People with low levels of calcium (hypokalaemia) can present with following symptoms:

• Muscle cramps, especially in back and legs
• Dry scaly skin
• Brittle nails
• More coarse hair than usual

If left untreated, hypokalaemia can cause:

• Confusion
• Memory problems
• Irritability or restlessness
• Depression
• Hallucinations
• Reduction in bone mineral density can eventually weaken your bones (osteopenia) and increase your risk for osteoporosis, leaving you with fragile, porous bones at a higher risk for breaks.

Severe hypokalaemia can cause:

• Tingling in lips, tongue, fingers or feet
• Muscle aches
• Muscle spasms in the throat that may lead to difficulty in breathing
• Stiffening and spasms of your muscles (tetany)
• Seizures
• Abnormal heart rhythms (arrythmias)
• Congestive heart failure (https://my.clevelandclinic.org/health/diseases/23143-hypocalcemia) 

What causes hypercalcemia or excess calcium in the body?

Calcium levels increase usually due to primary hyperparathyroidism or certain cancers, but it can also happen when you consume too much:

• Calcium supplements
• Vitamin A or D
• Antacid tablets or chews (like Tums® or Rolaids®), which are made of calcium carbonate.

Hypercalcemia usually settles down by stopping excess consumption, however, if left untreated can increase the risk of heart attack and other health issues. 

What are the symptoms of excess calcium or hypercalcemia?

• Stomach upset or pain, vomiting, and constipation.
• Most often, the extra calcium in the blood is leached from the bones. This weakens the bones. It can cause bone pain and muscle weakness.
• Hypercalcemia can affect how the brain works. That can lead to trouble focusing, confusion, drowsiness and fatigue. It also can cause depression.
• Rarely, serious hypercalcemia can affect the heart. It can cause feelings of a fast-beating, fluttering or pounding heart. It also can cause the heart to beat out of rhythm. It's linked with other heart-related conditions as well. (https://www.mayoclinic.org/diseases-conditions/hypercalcemia/symptoms-causes/syc-20355523) 

Excess calcium can overload the kidneys and can cause serious thirst and frequent urination.