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CASE STUDY ON PATIENT WITH END STAGE RENAL DISEASE AND CALCIUM DEFICIENCY

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by farhana zahid on 20 May 2014

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Transcript of CASE STUDY ON PATIENT WITH END STAGE RENAL DISEASE AND CALCIUM DEFICIENCY

CASE STUDY ON PATIENT WITH END STAGE RENAL DISEASE AND CALCIUM DEFICIENCY
Compromised vitamin D status and inadequate calcium nutrition are predisposing conditions for a great number of other diseases,
Various types of cancer
Diabetes
Tuberculosis
Periodontal diseases
Chronic infectious, inflammatory and autoimmune diseases
Metabolic disorders
Hypertension and cardiovascular diseases

ESRD since 1 year and 5 months
She is admitted to hospital four times since she was diagnosed with ESRD.
She had abdominal discomfort and muscle cramps since 2 months and shivering and vomiting during dialysis
Patient is suffering from anorexia and depression
Sumaira, 18 years old is a case of ESRD,
MEDICAL HISTORY
Laboratory data
Albumin 3.3 gm/dl
BUN 43 mg/dl
Creatinine 6.8mg/dl
Sodium 144 mmol
Potassium 5.5mmol
Calcium 7.6 mg/dl

Iron 110
Hb 8.6mg/dl
Anthropometric data
Height : 5 feet 4 inches
Weight : 49 kg
BMI: 19
Drug history
Gravinate
Mepressin
Beneane
Torado
Bone one
DIETARY HISTORY
Patient consumed
fruit cake with tea in breakfast
Carbonated drinks and french fries almost everyday
Patient avoids
vegetables
Ca balance is altered in kidney disease patients.
Low serum Ca is a salient feature of kidney disease and is a component of the syndrome of secondary hyperparathyroidism.
What is hypocalcemia?
Renal Osteodystrophy
Hypocalcemia is a diminished calcium level, below 8.5 mg/dL, in the bloodstream. Calcium is vital to the body for the formation of bones and teeth, blood coagulation, nerve impulse transmission, cell permeability, and normal muscle contraction.
Hypocalcaemia and muscle cramps in ESRD
Noordzij et al. reported on the results of a trial of 1,469 consecutive patients who started hemodialysis that was designed to investigate the effects of disordered plasma calcium levels according to KDOQI guidelines on the risk for muscle complaints Compared with dialysis patients who met the corrected calcium target of 8.4–9.5mg/dl, the risk for muscle pain was reduced in patients with corrected calcium levels <9.5mg/dl (odds ratio [OR] 0.6, 95% CI 0.3–0.9). However, there was an increased OR of 1.2 for muscle cramps in patients with low calcium Levels.
Hypocalcaemia and anorexia
Patients on dialysis experience appetite loss or anorexia as well. In the Hemodialysis (HEMO) trial, Burrowes et al found that approximately 32% of dialysis patients had fair or poor appetite (Nephrol Dial Transplant. 2005;20:2765-2774).
Calcium and phosphorus imbalance
Acidosis
leading to a host of metabolic alterations such as hyperventilation, anorexia, headache,
stupor, catabolism, and hyperkalemia
Hypocalcemia and depression
Calcium Requirements
Even with calcium levels of 6 to 7 mg/dl, minor muscle cramps, fatigue and mild depression may be the only symptoms.
Not more than 1 exchange from milk group in a day
Anesthesia and Uncommon Diseases By Lee A. Fleisher, 2012
normal individual 1000-1200mg
ESRD patient on dialysis
Fulfill calcium requirements from calcium supplements
thank you
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