For total calcium

E103 Chan, K.-M., Arriaga, C., Landt, M., Smith, C.H. and Ng, R.H. (1983). Interference by hemolysis with various methods for total calcium and its correction by trichloroacetic acid precipitation. Clin. Chem. 29, 1497-1500. 

Adverse effects of oral calcium and vitamin D supplementation include hypercalcemia and hypercalciuria, especially in the hy-poparathyroid patient, in whom the renal calcium-sparing effect of parathyroid hormone is absent. Hypercalciuria may increase the risk of calcium stone formation and nephrolithiasis in susceptible patients. One maneuver to help prevent calcium stones is to maintain the calcinm at a low normal concentration. Monitoring 24-hour urine collections for total calcium concentrations (goal <300 mg/24 h) may also minimize the occurrence of hypercalciuria. The addition of thiazide dinretics for patients at risk for stone formation may result in a reduc-tionof both urinary calcium excretion and vitamin D requirements." ... 

Ionized calcium and total calcium measurements are both performed with PVC-type electrodes. Membranes based on lipophilic alkyl phosphates with phosphonate plasticizers have only marginal selectivity over magnesium but have been used in the past to determine ionized calcium (i.e., free calcium) in undiluted blood samples (M8). Interference from protons at low pHs prevents such membranes from being employed for total calcium determinations on samples diluted with acid. Use of ionophore ETH 1001 (see Fig. 2) overcomes any concerns about selectivity, whether from magnesium or pH, and is now the neutral carrier system most often utilized within analyzers to detect ionized or total calcium. 

Flame atomic absorption spectrometry FAAS measurements are performed at the calcium resonance line at 422.7 nm using an air-acetylene flame. SrCli may be used as the internal standard. Before analysis, samples are diluted and the viscosity of the analytical portion and of the calibrator solution is adjusted. Phosphate ions form thermally stable calcium salts, which then escape atomization and measurement. For this reason. Lads is added, which binds phosphate ions enabling accurate calcium measurements independent of the (varying) phosphate concentration. FAAS is considered to be the most reliable technique for total calcium determination, and therefore it has been chosen as the reference method. 

Analytical reliability In routine clinical laboratories, imprecision between days for total calcium concentration measurements should be below a coefficient of variation of 3.0%, and deviation from the target value should not exceed 5% to meet clinical requirements. 

Definite Method. The definitive method for total calcium measurement is isotope dilution mass spectroscopy [9]. It has strict performance guidelines and is the accuracy standard against which all methods should be compared. 

Most potentiometric electrodes are selective for only the free, uncomplexed analyte and do not respond to complexed forms of the analyte. Solution conditions, therefore, must be carefully controlled if the purpose of the analysis is to determine the analyte s total concentration. On the other hand, this selectivity provides a significant advantage over other quantitative methods of analysis when it is necessary to determine the concentration of free ions. For example, calcium is present in urine both as free Ca + ions and as protein-bound Ca + ions. If a urine sample is analyzed by atomic absorption spectroscopy, the signal is proportional to the total concentration of Ca +, since both free and bound calcium are atomized. Analysis with a Ca + ISE, however, gives a signal that is a function of only free Ca + ions since the protein-bound ions cannot interact with the electrode s membrane. 

LSI Langelier Saturation Index indicates the corrosive (negative) or scale-forming (positive) characteristics. Hardness Expressed as CaC03, this is the total calcium and magnesium salts in the water. Hardness figures given as ppm or mg/1 are important, as the compounds of these two elements are responsible for most scale deposition. 

Calculate the volume of standard EDTA solution equivalent to the magnesium by subtracting the total volume required for the calcium from the volume required for the total calcium and magnesium for equal amounts of the test sample. 

Anion Interstitials The other mechanism by which a cation of higher charge may substitute for one of lower charge creates interstitial anions. This mechanism appears to be favored by the fluorite structure in certain cases. For example, calcium fluoride can dissolve small amounts of yttrium fluoride. The total number of cations remains constant with Ca +, ions disordered over the calcium sites. To retain electroneutrality, fluoride interstitials are created to give the solid solution formula... 

Calcium ion-selective electrodes have recently been commercialized for the measurement of either total or ionized calcium Approximately 45 % of the calcium present in serum is bound to proteins, 5% is complexed to simple anions and 50% exists as the free ion. Traditionally, total calcium measurements have been made by releasing the protein bound fraction. An ion-selective electrode has now allowed the free (ionized) calcium to be measured directly. There has been much debate on the clinical significance of these measurements. The dependence of ionized calcium on pH must be considered. Samples must be either treated anaerobically, tonometered to a constant pH or have a correction factor applied. 

Calcium exists in the human body as Ca(II) protein-bound and free Ca (II) ions (Dilana et al. 1994). For total extracellular Ca in plasma, serum and urine a definitive isotope dilution-mass spectrometry (ID-MS) method exist. Free Ca(II) in plasma/serum can be determined with PISE, but no definitive and reference methods exist. For Ca in faeces, tissue and blood flame atomic absorption (FAAS) is used widely. 

For acute symptomatic hypocalcemia, 200 to 300 mg of elemental calcium is administered IV and repeated until symptoms are fully controlled. This is achieved by infusing 1 g of calcium chloride or 2 to 3 grams of calcium at a rate no faster than 30 to 60 mg of elemental calcium per minute. More rapid administration is associated with hypotension, bradycardia, or cardiac asystole. Total calcium concentration is commonly monitored in critically ill patients. Under normal circumstances, about half of calcium is loosely bound to serum proteins while the other half is free. Total calcium concentration measures bound and free calcium. Ionized calcium measures free calcium only. Under usual circumstances, a normal calcium level implies a normal free ionized calcium level. Ionized calcium should be obtained in patients with comorbid conditions that would lead to inconsistency between total calcium and free serum calcium (abnormal albumin, protein, or immunoglobulin concentrations). For chronic asymptomatic hypocalcemia, oral calcium supplements are given at doses of 2 to 4 g/day of elemental calcium. Many patients with calcium deficiency have concurrent vitamin D deficiency that must also be corrected in order to restore calcium homeostasis.2,37,38... 

Because the severity of symptoms and the absolute serum concentration are poorly correlated in some patients, institution of therapy should be dictated by the clinical scenario. All patients with hypercalcemia should be treated with aggressive rehydration normal saline at 200 to 300 mL/hour is a routine initial fluid prescription. For patients with mild hypocalcemia, hydration alone may provide adequate therapy. The moderate and severe forms of hypercalcemia are more likely to have significant manifestations and require prompt initiation of additional therapy. These patients may present with anorexia, confusion, and/or cardiac manifestations (bradycardia and arrhythmias with ECG changes). Total calcium concentrations greater than 13 mg/dL (3.25 mmol/L) are particularly worrisome, as these levels can unexpectedly precipitate acute renal failure, ventricular arrhythmias, and sudden death. 

P. Anker, E. Wieland, D. Ammann, R.E. Dohner, R. Asper, and W. Simon, Neutral carrier based ion-selective electrode for the determination of total calcium in blood-serum. Anal. Chem. 53, 1970-1974... 

Blood samples were centrifuged at 1000 x g for 20 min at 0-4°. Ionized calcium levels were immediately determined in serum and urine samples using a calcium ion-selective electrode (Ionetics, Inc., Costa Mesa, CA) urine volumes were recorded. The remaining serum and urine were aliquoted for various analyses and stored at -40°. Serum insulin was analysed by radioimmunoassay (Amersham Corp., Arlington Heights, IL). Serum levels of total calcium, phosphorus and creatinine as well as urine creatinine were determined by colorimetric procedures using an automated analyzer (Centrifichem, Baker Instruments Corp., Pleasantville, NY). Glomerular filtration rates (GFR) were calculated from serum and urine creatinine data GFR = urine creatinine/serum creatinine. 

The method described above for total ash present in crude drugs containing calcium oxalate has certain serious anomalies, namely ... 

Dissolved Concentrations of Calcium and SO2 Species. The equilibrium dissolved concentrations of total calcium and SO2 (sulfite plus bisulfite) species are important because comparison of these equilibrium concentrations with actual measured values determines the degree of gypsum saturation, and hence the potential for gypsum scale formation in the scrubber. As a first approximation, the fraction gypsum saturation of a scrubber liquor, having specified pH and specified concentrations of magnesium and chloride, is proportional to the measured calcium concentration, and inversely proportional to the measured S02 concentration. 

CalcitrioPs action primary function is in regulating plasma calcium concentration. In health, the plasma total calcium concentration is tightly controlled at 2.35-2.55 mmol/1. Only the ionized or free fraction, amounting to about 50% of the total, is physiologically active in for example, maintenance of membrane electrical potential and bone formation. The hormone causes increased bone resorption via activation of osteoclasts (see Section 9.4) and increased intestinal absorption of calcium following the synthesis of a specific binding protein in mucosal cells. As described in Section 4.7, some... 

The 2003 threshold limit value-time-weighted average (TLV-TWA) for calcium silicate is lOmg/m for total dust containing no asbestos and <1% crystalline silica. 

As the Kawasaki research team mentioned earlier nave concluded, there is also, with calcium, a Ca/S requirement as with the REM S for total MnS substitution 32), They have proposed the most reliable estimate so far of retained calcium requirement for "homogeneous sulfide shape control" which is summarized in Table IV and Figure 17. 

This method is used for water with a varying salt content, but with a view to the weakly alkaline reaction in the solution in titration, one should never have a total calcium and magnesium ion concentration in a water sample exceeding 0.5 mg-equiv/litre. There-... 

Some surface water supplies have only 10 to 50 ppm or more of total calcium and magnesium hardness they are naturally soft waters and may also be described as lean waters, due to dissolved solids from all sources being limited to perhaps only 30 to 60 ppm TDS. Cooling systems using this quality of water as makeup may employ cycles of concentration (COC) of 7 to 1 Ox or more. Control of hardness scales tends not to be an onerous task for modem polymeric scale inhibitors, but lean water formulations must allow for more aggressive conditions and a real risk of some metal wastage. 

When compared with 12 healthy matched controls, 13 women who had taken lithium for a mean of 8 (range 3-16) years had higher mean ionized and total calcium concentrations, but mean plasma parathormone concentrations did not differ. In eight of the women taking lithium, the calcium concentration was above the upper end of the reference range, and in one the parathormone concentration was abnormally high (661). 

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