Since the publication of this video 9 years ago, the practice of "correcting" the calcium for hypoalbuminemia has been called into question, and the availability of ionized calcium levels has increased. A nice summary of this change in thought: www.ncbi.nlm.nih.gov/pmc/articles/PMC8340960/
Absolutely worth every single seconds of it to watch!!! HIGHLY RECOMMENDED !! Thank you honestly for explaining this concept in such a wholesome, yet understanble way!👌💥
This might help some of you better understand the role of calcitriol: The observation that calcitriol stimulates the release of calcium from bone seems contradictory, given that sufficient levels of serum calcitriol generally prevent overall loss of calcium from bone. It is believed that the increased levels of serum calcium resulting from calcitriol-stimulated intestinal uptake causes bone to take up more calcium than it loses by hormonal stimulation of osteoclasts. Only when there are conditions, such as dietary calcium deficiency or defects in intestinal transport, which result in a reduction of serum calcium does an overall loss of calcium from bone occur. Calcitriol also inhibits the release of calcitonin, a hormone which reduces blood calcium primarily by inhibiting calcium release from bone
I also got skeptical when he said that Calcitriol increases bone resorption. Vit-D (Calcitriol) is being prescribed for stronger bones, that's how you keep it in mind.
i agree dr. eric abt the role of vitamin d u have mentioned.. thank u for sharing ur experience sir.. please keep on updating videos on you tube.. great job
seriously nobody explains the metabolism and biochemistry stuff in this simple way..Great teaching stuff here will recommend these videos to every other student like me who fails to understand biochemistry
I landed on this video after after curiosity on why most institutions recommend 1000mg of calcium in the U.S for adults? I read Harvard studies on why the USDA recommendations may be off because the study was done for a short time period. Also how much calcium does the GI tract absorb and typically how much calcium does the average human being absorb in a day?
Interesting. I'm a Capricorn and calcium phosphate is the cell salt that Capricorns need. All my life I've had different issues that can point back to calcium phosphate deficiency. Right now I'm dealing with lots of joint pain and slow muscle recovery. Gonna be supplementing with calcium phosphate soon.
Thanks for the video. I am still a little unclear about why it would be a problem to test for calcitriol. How do the regulatory mechanisms acting on 1-alpha hydroxylase partially compensate for vitamin D deficiency?
Hi Dr. Strong, long time listener first time commenting! I'm confused about the acid-base effect on calcium. I was under the impression that in acidic environments the H+ ions will accumulate and start to bind to albumin, which will in turn displace calcium --> ↑ free calcium. If there's increased calcium wouldn't the CaSR detect high calcium and therefore decrease PTH secretion? Thank you for your time!
just a question i have hypothyroidism high para thyroid hormone pth is 10.9 should be under 7 phosphates level is 1.9 nnmols no kidney damage but liver bones joints and heart puputation and insomnia and fatage and diarrhea if i cant get to the bottom of this i wont live long and dockters wont help me with a diagnoses im dieing and i dont know how to fix it wen i dont know what is causing it.
Great videos! I am super grateful for finding this channel! I must ask one question: it is unclear for me why measure calcidiol, since calcitriol could be successfully compensated - why would you want to confirm a metabolic issue since calcitriol production is eventually compensated? Thank you in advance!
hello doctor, thank for your video very helpfull, there is something i don't anderstand about calcium . you said that we measured the total serum calcium, if we have low albulmin i think they will be more free calcium and more complexed calcium, and the total serum calcium will not change, why we have to corrected the total serum calcium for hypoalbuminemia. thank you.
TheResetmc I suppose if a significant portion of a patient's albumin could be removed in a very short period of time, it might be true that the previously-albumin-bound calcium would become free calcium, and the total would be the same. However, albumin levels usually decrease very slowly (weeks to months), and as the bound calcium is released and becomes free calcium, the body's hormonal responses see that as "extra" calcium (since regulatory hormones are acting only in response to circulating, free ionized calcium). Thus, the body experiences a slight down regulation of PTH, which results in slight decreases in the level of active vitamin D - the combination of which results in less GI calcium absorption, and more renal calcium wasting. It's not a dramatic effect at any given time, and if PTH and vitamin D levels are measured, they will still probably look to be in the normal range. But even imperceptible changes in hormones, when continued over the weeks and months that it typically takes albumin levels to drop (for example, from malnutrition), the body's total calcium levels can become too low. Thus, the albumin-bound calcium levels will be low, the total calcium levels will be low, but the free ionized calcium levels will usually remain normal. Keep in mind, that the correction formula cited in the video may be commonly used in practice, but it's just an approximation. I've seen people whose corrected calcium is calculated as normal, but when ionized calcium is directly measured, it's found to be low. And conversely, people whose corrected calcium is corrected as low, but ionized calcium is measured as normal.
Eric's Medical Lectures ok it's clear but i have one more reflexion, so the corrected calcium, it's like your video about the delta ion gap, it's usefull to know if there is a real hypocalciemia , ad esample if the measured calcium is low and the corrected calcium is normal, that mean that the problem it's not a real hypocalcemia by loosing calcium, but a problem with albumin, and if the measured calcium is low and the corrected calcium also low that mean a real hypocalciemia. and if the measured calcium is low and the corrected calcium is high (i don't know if it's possible) that mean that we have hypoalbuminemia + hypercalciemia. ????
TheResetmc Yes, that's correct. However, if the total calcium is low, but the corrected calcium is high, it implies some pretty profound hypoalbuminemia, which probably makes the correction formula even less accurate than normal. Therefore, that would be a situation in which it's probably worth getting an ionized calcium to double check.
Albumin in g/dL. The normal range in these units is usually given by references as ~3.5-5.5 g/dL, with some slight variation depending upon the specific lab, but in my personal observation, it's very unusual for a healthy, dehydrated person to have an albumin >5.0 g/dL.
Thank you - clinically taking both Phosphate and Albumin into account we use the formula; Corrected Ca (mmol/L) = serum Ca total (mmol/L) * (0.02 * (40- Albumin gm/L) * (1.5- Phosphate mmol/L) the analysis is 2.2 is seen in calcification of tissue = cancer
well i have high pth 10.9 and normal calcium with high phosphate no kidney problem but do have liver problems bone and joint and stomach dockter said im a anomoly one shoud be high and another low not both pth and phaspate im dieing and need help diagnoseing this condition undiagnosed for 10 years and getting worse, i have heart puputation and also i have num arms and legs that cant move for 5 minits and above wen not laying on them.
can someone tell me if I understood it correctly ? We should measure calcidiol levels instead of calcitriol because if your kidneys work well they would get stimulated to convert calcidiol into calcitriol and in our results calcitriol would be in sufficient level, but if we measure calcidiol we can see direct deficiency.
+Ameen Awni Thanks for the comment. The effect is probably not clinically significant, but the evidence (which is, admittedly, partially extrapolated from animal research) shows that low pH (too many H+) increases PTH secretion. As the video describes, the consequence would be more decreased reuptake of phosphate in the tubules, which would increase the presence of phosphate in the tubule lumen that could buffer excreted H+ ions - thus working towards normalization of pH. See: www.ncbi.nlm.nih.gov/pubmed/16502126 (not an awesome resource, but the best one I could find with a direct link on-line). If you have a contradictory source, please let me know so I can take a look!
CORRECTION ,great lecture but...still some false assumptions . HOMEOSTASIS IS CENTRAL . Correction the homeostatic feedback of calcium phosphate ions and corresponding complexes does NOT begin in the GI tract from an evolutionary perspective thiscant be correct ,from a speculative esoteric or metaphysical perspective the human body is qork in progress ,IT BEGINS with internalised modification of bone and other stored sources of these complexed ionic metals ,the body during periods of fasting etc as would be the norm on primitive cultures 1000 years ago would have such periods naturally ,no overeating or sugars or refined foods ,the body then would re structure autophagy and virtually in a microscopic way change suit hingon and off certain gene cluster,SO NO it begins INTERNALLY,then draws on externals ie food source as and when needed ,my speculation hypothesis or idea ? excuse typos big fingers small phone
+H8ts Just because medical science hasn't yet explained every single small detail of our physiology and biochemistry, doesn't mean that we can't explain the vast majority of how our body works, and also doesn't mean that we can't appropriately treat the overwhelming majority of pathology.
U actually offended a community that works their asses off day and night for the human betterment . Just because u have had sour experience in the past doesn’t mean u can typecast a whole community .. that was indeed a very shallow comment .. if u cannot trust doctors then become one, or raise one to become a doctor ,marry one
@11:30, if calcitriol only stimulates bone resorption, why do patients with rickets (who have a deficiency of vitamin D) have fragile bones? (Inhibition of resorption should lead to thicker bones, shouldn't it? )
At 6.49, with decrease in pth secretion, you said that it wil lead to hypocalcemia. But , i think the otherwise is true as they are inversely proportional.
@Avishee Annie i think it was relating to MILD low Mg levels which normally behave like low calcium and increase PTH, but, SIGNIFICANT decreases in Mg lower the PTH and also lead to PTH resistance, therefore leading to low PTH and low Ca (irrespective of ? Ca ?) , thus leading to hypocalcemia..bcoz here the PTH is suppressed by the mkdly low Mg...this is my understanding :)
Magnesium balance is covered in a separate video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-L932sS20Tek.html Some of the interactions with calcium and overlapping effects are discussed there.
Thanks Dr Strong , good lecture. Anyhow this was 6 year ago , may be you can update the role of Vit D in fighting infection if any , and wether how much one should take as supplement indeed ? Is there a consensus now what is the normal level of VIT D ?
