Calcium state
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Understanding Calcium State: Key Insights from Recent Research
Total Calcium and Ionized Calcium: Diagnostic Implications
Total Calcium (TCa) and Albumin-Adjusted Calcium
Total blood calcium (TCa) is a common metric used in diagnosing and managing mineral and bone metabolism disorders. However, the accuracy of TCa, especially when adjusted for albumin levels, has been questioned. A large retrospective study analyzed 5055 samples to compare the agreement rates between ionized calcium (iCa) and TCa or albumin-adjusted calcium measurements. The study found that the Payne formula, commonly used for albumin adjustment, performed poorly in patients with abnormal albumin, eGFR, or pH levels, often overestimating the calcium state in up to 80% of cases with low albumin or blood pH disorders 1. The study concluded that iCa should be the reference method for determining the real calcium state due to its higher accuracy.
Ionized Calcium (iCa)
Ionized calcium, the free, hydrated cation in solution, is a crucial physiological mediator in various metabolic and regulatory processes. It is frequently assayed in patients with suspected or known calcium metabolism disorders. There is ongoing debate about whether direct measurement of iCa, TCa, or albumin-adjusted calcium is the best clinical measure, as each method varies in cost and clinical sensitivity 8. The consensus leans towards iCa for its direct reflection of physiologically active calcium.
Calcium Homeostasis and Balance
Calcium Homeostasis
Calcium homeostasis involves the hormonal regulation of serum ionized calcium by parathyroid hormone, 1,25-dihydroxyvitamin D, and serum ionized calcium itself. These hormones regulate calcium transport in the gut, kidneys, and bones. Disruptions in this balance can lead to hypercalcemia or hypocalcemia, indicating serious health issues 3.
Calcium Balance
Calcium balance refers to the state of calcium body stores, primarily in bones, influenced by dietary intake, intestinal absorption, renal excretion, and bone remodeling. Factors such as growth, aging, and various disorders can affect whether the bone calcium balance is positive, neutral, or negative. In patients with chronic kidney disease and mineral bone disorders (CKD-MBD), calcium balance and homeostasis are often disrupted, necessitating tailored dietary and supplemental calcium requirements 3.
Cellular Calcium States and Signaling
Calcium in Marine Organisms
Marine organisms, such as sea urchin larvae, concentrate calcium ions from seawater to form mineralized skeletons. Research has shown that within the spicule-building cells of sea urchin larvae, calcium exists in a continuum of states, from solution to solid, indicating a gradual increase in concentration until mineral deposition occurs. This process may be relevant to other mineralizing organisms, enhancing our understanding of biomineralization 4.
Calcium Signaling in Mammalian Cells
Calcium ions regulate diverse cellular processes, including cell motility, gene transcription, muscle contraction, and exocytosis. In striatal medium spiny neurons (MSNs), state transitions significantly influence calcium signaling. Upstate transitions alter the available voltage-sensitive calcium channels (VSCCs) and change the dominant synaptic calcium source, impacting synaptic plasticity and gene expression 9. Additionally, distinct cellular states within a population can lead to variability in calcium signaling responses, emphasizing the need for single-cell parameter inference to uncover hidden population structures 7.
Conclusion
Calcium plays a vital role in various physiological processes, and accurate measurement of its state is crucial for diagnosing and managing related disorders. Ionized calcium is emerging as the preferred method for assessing calcium state due to its direct reflection of physiologically active calcium. Understanding calcium homeostasis and balance, as well as the cellular mechanisms of calcium concentration and signaling, is essential for advancing medical and biological research.
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Calcium state estimation by total calcium: the evidence to end the never-ending story
Ionized calcium measurement is more accurate than total and albumin-adjusted calcium measurements in determining the real calcium state, with better agreement in patients with abnormal albumin levels or blood pH disorders.
Observational StudyCalcium
Adequate calcium intake is crucial for maintaining bone health, heart function, nerve transmission, and blood clotting, as well as reducing the risk of osteoporosis, colon polyps, colon cancer, calcium oxalate kidney stones, and hypertension and cholesterol.
Highly CitedCalcium metabolism in health and disease.
Calcium supplementation may increase soft tissue calcification and cardiovascular disease in patients with chronic kidney disease and mineral bone disorders.
Literature ReviewHighly CitedCellular pathways of calcium transport and concentration toward mineral formation in sea urchin larvae
Sea urchin larvae use a complex cellular process to concentrate calcium ions into mineralized skeletons, with calcium concentration increasing gradually in each vesicle until mineral deposition.
In Vitro StudyProperties and long range interactions of the calcium atom.
The study reveals that the low-lying states of calcium have polarizabilities and dispersion interactions with the ground state, hydrogen, and rare gases, affecting their reactivity and stability.
Distinct cellular states determine calcium signaling response
Distinct cellular states within a population of cells may contribute to the observed variability in calcium signaling response, suggesting structured heterogeneity between cells.
Highly CitedIonized calcium.
Ionized calcium testing is a useful and cost-effective method for assessing calcium homeostasis in patients, but other methods may be more practical and cost-effective for specific conditions.
Highly CitedState-Dependent Calcium Signaling in Dendritic Spines of Striatal Medium Spiny Neurons
State transitions in striatal medium spiny neurons alter calcium signaling in dendritic spines, potentially affecting synaptic plasticity and gene expression.
In Vitro StudyHighly CitedCalcium Signaling
Calcium ions play a crucial role in regulating various cell biological processes, including motility, gene transcription, muscle contraction, and exocytosis.
Highly Cited