Calcium + Vitamin D3 + Amino acids Pharmacology
Calcium + Vitamin D3 + Amino acids
2.Rickets
3.Osteocalcaemia
4.Osteoporosis in males
Calcium
Plasma concentration of calcium is kept in normal range by three endocrine factors which control metabolism of calcium. These are (a) Parathyroid hormone, (b) Calcitonin, (c) Vitamin D. Calcium in plasma is bound to albumin, is complexed with anions (e.g. phosphate) and as diffusible ionic calcium. The physiological effects are exerted by ionic calcium. The predominant source of calcium is dairy products and the daily intake varies from 200 - 2500 mg. Adequate calcium intake is particularly important during periods of bone growth in childhood and adolescence and during pregnancy and lactation.
Patients with advanced renal insufficiency exhibit phosphate retention and some degree of hyperphosphataemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy and soft tissue calcification. Calcium acetate, when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the faeces.
Deficiency signs and symptoms: Osteoporosis, pathological fractures, brittle nails and hair.
A-V conduction. Calcium is also required for blood-coagulation.
2.Bloating
3.Excess gas
4.Anorexia
5.Nausea
6.Vomiting
7.Abdominal pain
8.Thirst
9.Hypercalcaemia
10.Polyuria
11.Dry mouth
12.Delirium
13.Confusion
2.Hypophosphataemia
3.Hypercalcaemia
4.Ventricular fibrillation.
2.Cardiac diseases
3.Sarcoidosis
4.Cor pulmonale
5.Respiratory acidosis
6.Respiratory failure
7.End stage renal failure
8.Hypoparathyroid patients
9.Digitalized patients
10.Prolonged use of therapeutic amounts.
2.Calcium and vitamin D deficiency
3.Calcium deficiency during pregnancy and lactation
4.Rickets
5.Prevention of osteoporosis in postmenopausal women
6.Chronic renal failure.
Hypocalcaemia:
Adults: 1g daily. Increases to 2g daily if required.
Prevention of osteoporosis: 1 to 1.5g daily.
Children: 45 to 65mg/kg daily.
Neonates: 50 to 150mg/kg and should not exceed 1g.
Vitamin D3
Distribution: Widely distributed in a protein bound form. It is stored in adipose tissue and liver.
Metabolism: It is hydroxylated in to both active and inactive metabolites and also metabolized in kidney.
Excretion: Metabolites are excreted mainly through bile.
2. Fatigue
3. Weakness
4. Diarrhoea
5. Vomiting
6. Sluggishness
7. Albuminuria
8. Polyuria
9. Calcification of soft tissues (blood vessels, parenchymal organs including heart)
10. Arrhythmias
11. Renal stones
12. Growh retardation in children
13. Hypertension
14. Anorexia
15. Nausea
16. Constipation
17. Elevated liver enzymes
2. Hypervitaminosis D
3. Renal osteodystrophy with hyperphosphatemia
4. Renal impairment
2. Renal stones
3. Cardiac diseases
4. Arteriosclerosis
5. Coronary diseases
2. Hypoparathyroidism
3. Fanconi`s syndrome
4. Osteoporosis
Digitalis glycosides: May precipitate cardiac arrhythmias due to hypercalcemia.
Verapamil: Atrial fibrillation may occur.
Cholestyramine: Intestinal absorption of Vitamin D may be reduced.
Mineral Oil: Prolonged use of mineral oil may result in reduced absoprtion of Vitamin D.
Phenytoin, Barbiturates: Half life of vitamin D may be reduced.
Thaizide diuretics: Hypoparathyroid patients on Vitamin D may develop hypercalcemia due to thiazide diuretics.
Adults:
Nutritional Rickets and Osteomalacia: 25 to 125mcg daily in normal gastrointestinal absorption. In severe malabsorption; 250mcg to 7.5mg orally or 250mcg I.M.
Vitamin dependent Rickets: 250mcg to 1.5mg daily
Hypoparathyroidism: 625mcg to 5mg daily with calcium supplements
Fanconi`s syndrome: 1.25 to 5mg daily
Osteoporosis: 25 to 250mcg daily or 1.25mg once weekly with calcium and fluoride supplements.
Hypophosphatemia: 250mcg to 1.5mg along with phosphate supplements
Children:
Nutritional Rickets and Osteomalacia: 25 to 125mcg daily in normal gastrointestinal absorption. In severe malabsorption; 250mcg to 625mcg orally
Vitamin dependent Rickets: 75 to 125mcg daily.
Fanconi`s syndrome: 625mcg to 1.25mg daily
Hypophosphatemia: 1 to 2mg daily with phosphate supplements. Increase the dose in increments of 250 to 500mcg at intervals of 3 to 4months until desired therapeutic response is obtained.
Amino acids
Amino acids are joined to each other by peptide bonds. A peptide bond is a chemical bond formed between two molecules (carboxyl group of one molecule reacts with the amino group of the other molecule), releasing a molecule of water (H2O). The resulting CO-NH bond is called a peptide bond, the chemical bond that links the amino acid monomers in a protein chain. Each protein has its own unique amino acid sequence that is known as its primary structure. Amino acids can be linked together in varying sequences to form a huge variety of proteins. The unique shape of each protein determines its function in the body.
Aminoacids are of 2 types, essential and nonessential. Essential amino acids are the ones that must be obtained in the diet and non-essential are synthesized within the body
Essential aminoacids: Methionine, Threonine, Tryptophan, Valine, Isoleucine, Leucine, Lysine, Phenylalanine, Histidine,
Nonessential aminoacids: Alanine, Asparagine, Aspartic acids, Proline, Glutamic acid, Glutamine, Serine
Amino acids Arginine, Cysteine, Glycine and Tyrosine are considered conditionally essential, meaning they are not normally required in the diet, but must be supplied exogenously to specific populations that do not synthesize it in adequate amounts
Histidine and Arginine are generally only considered essential in children, because the metabolic pathways that synthesize these amino acids are not fully developed in children.
Nutritional role of aminoacids: Aminoacids have been used orally or in relatively dilute solutions intravenously as supplementary nutrients for patients unable to metabolize intact protein adequately. For patients in whom oral or tube feeding is contraindicated or Inadequate good nutrition may be achieved or maintained by intravenous feeding known as total parenteral nutrition or intravenous or parenteral hyperalimentation. Such feeding provides essential nutrients in a sufficiently concentrated form that does not exceed normal daily fluid requirements.
2.Pre and post surgery
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