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BACKGROUND: The formula, referenced in major textbooks, for albumin corrected calcium [Calcium(alb)] may not accurately depict ionized calcium [ICa]. We evaluated the accuracy of unadjusted calcium [Calcium(Unadjusted)] and [Calcium(alb)], and developed a protocol for local laboratory adjustment of calcium for albumin. METHODS: Laboratory data were obtained from an electronic health record. Assessments were accuracy, false positive, and false negative rates. Clinical reliability was defined in "error zones" for calcium [Ca]: Zone A = Ca(normal), ICa(low); Zone B = Ca(low), ICa(normal); and Zone C = Ca(normal), ICa(high), Zone D = Ca(high), ICa(normal). RESULTS: A linear regression from 468 laboratory tests was used to derive a formula for "revised corrected calcium" [Calcium (revised)] over a range of albumin concentrations where, [Calcium (revised)] = plasma calcium (mg/dl) + [(4- Albumin (g/d)L)]*(plasma calcium (mg/dl)*0.052)]. [Calcium(alb]] vs [Calcium(Unadjusted)] decreased zone B errors 12%, [95%CI;8-15%], vs 44% [95%CI;37-50%], p < 0.001. However, [Calcium(alb]] vs [Calcium(Unadjusted)] increased zone A error (60%,[95%CI;42-78%], vs 7% [95%CI;1-13%], p < 0.001). [Calcium (revised)] decreased zone A errors (15%, [95%CI;6-24%]) vs [Calcium(alb) ] (60% [95%CI;42-78%], p < 0.001) and Zone D errors from 9% [95%CI;6-12%] to 2% [95%CI;1:5%, p < 0.001]. CONCLUSIONS: [Calcium(alb)] is unreliable in hypo- or hypercalcemia. We provide a protocol for locally derived correction of calcium for albumin.

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Fish mortality is associated with harmful algal blooms, although whether toxicity is related directly to the presence of cyanotoxins or the prevailing water chemistry remains unclear. Similarly, while planktivorous fish may be exposed to toxin through the diet, the hazard posed by waterborne extracellular toxin to carnivorous fish is less well understood. In this study rainbow trout (Oncorhynchus mykiss) were exposed for up to 28 d to waterborne microcystin-LR at nominal concentrations of 1.5 and 50 µg L-1 (measured values 2 and 49 µg L-1, respectively). The former represents the Canadian drinking water guideline, and the latter an elevated environmental level. This study hypothesised that waterborne toxin exposure would specifically impact gill function, and given the importance of this tissue in freshwater fish ion regulation, effects on plasma ions and branchial ion transporter activity would be observed. Microcystin-LR exposure resulted in a significant and persistent hypocalcaemia at the higher exposure concentration, but plasma sodium and branchial activities of the sodium/potassium ATPase, proton ATPase and calcium ATPase enzymes remained unaffected. An in vitro assessment failed to show any effect of microcystin-LR on branchial calcium ATPase activity even at exposure concentrations as high as 1000 µg L-1. A transient increase in hepatic alkaline phosphatase activity was also observed at 49 µg L-1, but there were no effects of toxin exposure on branchial or hepatic lactate dehydrogenase activity. These results suggest that microcystin-LR exposure does not have a general effect on ion regulation, but instead produces a novel and specific impact on calcium metabolism in rainbow trout, although the mechanism underlying this effect remains unknown.

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BACKGROUND: Previous studies indicate hypocalcaemia as a potential diagnostic and prognostic marker of corona-virus disease 2019 (COVID-19). Our aim was to investigate these relations in more detail in a large test cohort and an independent validation cohort. METHODS: We retrospectively included 2792 COVID-19 suspected patients that presented to the emergency department (ED) of two hospitals. Plasma calcium and ionized plasma calcium levels were compared between COVID-19 positive and negative patients, and between severe and non-severe COVID-19 patients using univariate and multivariate analyses in the first hospital (N = 1363). Severe COVID-19 was defined as intensive care unit (ICU) admission or death within 28 d after admission. The results were validated by repeating the same analyses in the second hospital (N = 1429). RESULTS: A total of 693 (24.8%) of the enrolled patients were COVID-19 positive, of whom 238 (34.3%) had severe COVID-19. In both hospitals, COVID-19 positive patients had lower plasma calcium levels than COVID-19 negative patients, regardless of correction for albumin, in univariate and multivariate analysis (Δ0.06-0.13 mmol/L, p < .001). Ionized plasma calcium concentrations, with and without correction for pH, were also lower in COVID-19 positive patients in multivariate analyses (Δ0.02-0.05 mmol/L, N = 567, p < .001). However, we did not find a significant association between COVID-19 disease severity and plasma calcium in multivariate analyses. CONCLUSIONS: Plasma calcium concentrations were lower in COVID-19 positive than COVID-19 negative patients but we found no association with disease severity in multivariate analyses. Further understanding of plasma calcium perturbation may facilitate the development of new preventive and therapeutic modalities for the current pandemic.

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The dietary cation-anion difference (DCAD) has been receiving increased attention in recent years; however, information on rumen fermentation, cellulolytic bacteria populations, and microbiota of female goats fed a negative DCAD diet is less. This study aimed to evaluate the feasibility of feeding a negative DCAD diet for goats with emphasis on rumen fermentation parameters, cellulolytic bacteria populations, and microbiota. Eighteen female goats were randomly blocked to 3 treatments of 6 replicates with 1 goat per replicate. Animals were fed diets with varying DCAD levels at +338 (high DCAD; HD), +152 (control; CON), and -181 (low DCAD; LD). This study lasted 45 days with a 30-d adaption and 15-d trial period. The results showed that the different DCAD levels did not affect the rumen fermentation parameters including pH, buffering capability, acetic acid, propionic acid, butyric acid, sum of acetic acid, propionic acid, and butyric acid, or the ratio of acetic acid/propionic acid (p > 0.05). The 4 main ruminal cellulolytic bacteria populations containing Fibrobacter succinogenes, Ruminococcus flavefaciens, Butyrivibrio fibrisolvens, and Ruminococcus albus did not differ from DCAD treatments (p > 0.05). There was no difference in bacterial richness and diversity indicated by the indices Chao, Abundance Coverage-based Estimator (Ace), or Simpson and Shannon, respectively (p > 0.05), among 3 DCAD levels. Both principal coordinate analysis (PCoA) weighted UniFrac distance and unweighted UniFrac distance showed no difference in the composition of rumen microbiota for CON, HD, and LD (p > 0.05). At the phylum level, Bacteroidetes was the predominant phylum followed by Firmicutes, Synergistetes, Proteobacteria, Spirochaetae, and Tenericutes, and they showed no difference (p > 0.05) in relative abundances except for Firmicutes, which was higher in HD and LD compared to CON (p < 0.05). At the genus level, the relative abundances of 11 genera were not affected by DCAD treatments (p > 0.05). The level of DCAD had no effect (p > 0.05) on growth performance (p > 0.05). Urine pH in LD was lower than HD and CON (p < 0.05). Goats fed LD had higher plasma calcium over HD and CON (p < 0.05). In summary, we conclude that feeding a negative DCAD has no deleterious effects on rumen fermentation and rumen microbiota and can increase the blood calcium level, and is therefore feasible for female goats.

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Purpose: The underlying causes of primary hypertension are not fully understood. Evidence on the relation of plasma calcium concentration with blood pressure (BP) is inconsistent and relies largely on studies utilizing office BP measurements in populations using cardiovascular drugs. In many studies adjustment for confounders was not optimal. In this cross-sectional study we examined the association of plasma total calcium concentration with the haemodynamic determinants of blood pressure.Subjects and methods: Supine haemodynamics were recorded using pulse wave analysis, whole-body impedance cardiography, and heart rate variability analysis in 618 normotensive or never-treated hypertensive subjects (aged 19-72 years) without diabetes, cardiovascular or renal disease, or cardiovascular medications. Linear regression analysis was used to investigate factors associated with haemodynamic variables.Results: Mean age was 45.0 years, body mass index 26.8 kg/m2, seated office BP 141/89 mmHg, and 307 subjects (49.7%) were male. Mean values of routine blood and plasma chemistry analyses were within the reference limits of the tests except for low-density lipoprotein cholesterol (3.05 mmol/l). In the laboratory, mean supine radial BP was 131/75 mmHg, and both systolic and diastolic BP correlated directly with plasma total calcium concentration (r = 0.25 and r = 0.22, respectively, p < 0.001 for both). In regression analysis plasma total calcium concentration was an independent explanatory variable for radial and aortic systolic and diastolic BP, and systemic vascular resistance, but not for cardiac output, pulse wave velocity, or any of the heart rate variability parameters.Conclusion: Plasma total calcium concentration was directly associated with systolic and diastolic BP and systemic vascular resistance in normotensive or never-treated hypertensive subjects without comorbidities and cardiovascular medications. Higher plasma calcium concentration potentially plays a role in primary hypertension via an effect on vascular resistance.

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This experiment was conducted to evaluate the effects of nanocalcium carbonate (NCC) instead of calcium carbonate (CC) on egg production, egg weight, egg mass, FCR, blood calcium and egg quality characteristics in laying hens. A total of 120 laying hens were used in a 10-weeks trial, from week 23 to 33 of age. Laying hens were randomly assigned to six treatments with four replications, five hens each. The experimental treatments involved replacing 50% of the CC in the diet by decreasing amounts of NCC and were T1 Basal diet (BD) with 8.06% CC; T2 (6.045% of CC as a negative control); T3 (4.03% of CC replaced by 2.015% NCC); T4 (4.03% of CC replaced by 1.01% NCC); T5 (4.03% of CC replaced by 0.252% NCC) and T6 (4.03 of CC replaced with 0.126%NCC).Egg weight was unaffected by dietary treatments (p > .05). However, the egg production percentage and egg mass in T6 were less than that of other treatments (p < .05). The laying hens in the control group had the best average feed conversion ratio (p < .05). Also, the lowest concentration of calcium in hens' blood was recorded for birds fed T6 (p < .05). The best egg shell quality (relative egg shell weight and egg shell weight/surface) was observed in T1 (p < .05).Collectively, our results demonstrated that NCC could replace CC at a lower inclusion level but extreme reduction of calcium concentration in diets (to 1.43% Ca in the T6 group) reduced production performance, egg quality characteristics, Tibia thickness and blood calcium of laying hens.

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To explore the impact of normal range plasma calcium level changes on fibrinogen and homocysteine (Hcy) in non-diabetic elderly patients. Methods: A total of 1030 non-diabetic patients≥65 years were retrospectively studied. According to adjusted plasma calcium concentration (Cac), the patients were divided into 4 quartiles as Q1 group, Q2 group, Q3 group and Q4 group. The relationship between Cac and plasma levels of fibrinogen and Hcy were compared. Results: ① Plasma levels of fibrinogen and Hcy were increased by Cac elevation accordingly, P=0.010 and P<0.001 respectively. ② Cac was obviously related to the prevalence of high fibrinogen (OR=1.75, P=0.019) and high Hcy (OR=1.82, P=0.026). ③ Cac was positively related to fibrinogen (Standardized β=0.15, P<0.001) and Hcy (Standardized β=0.08, P=0.009). Conclusion: Normal range plasma calcium level changes were related to the elevation of plasma fibrinogen and Hcy in non-diabetic elderly patients.

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OBJECTIVE: To investigate associations between plasma calcium and future incidence of hypertension in a healthy population. METHODS: We used prospective data from Ansung and Ansan cohorts (n = 10,038) of the Korean Genome and Epidemiology Study. Data from baseline (2001-02) to the fourth study (2007-08) were used. After excluding hypertensive cases at baseline, missing data, and outliers, 5560 participants were analyzed. Propensity scores for having higher plasma calcium (≥2.37 mmol/L) were created for each participant. After propensity score matching (1:1 nearest neighbor matching within caliper), 2153 pairs were left for analysis. Factors that were significantly different between the lower and higher plasma calcium groups before matching either became nonsignificant or the difference decreased in size. RESULTS: Using multivariable Cox proportional hazard models with robust standard errors accounting for clustering of matched pairs, higher plasma calcium was associated with higher incidence of hypertension (adjusted HR, 1.24; robust 95%CI, 1.07-1.43). Among those with higher plasma calcium, low dietary calcium intake increased the development of hypertension, but the effect was not significant. Sensitivity analysis showed that our results were robust to hidden bias. CONCLUSIONS: Plasma calcium was positively associated with incidence of hypertension. These results expand on cross-sectional associations between hypercalcemia and the metabolic syndrome, and extend the link to future risk of hypertension.