Calcium state estimation by total calcium: the evidence to end the never-ending story.

Background Total blood calcium (TCa) is routinely used to diagnose and manage mineral and bone metabolism disorders. Numerous laboratories adjust TCa by albumin, though literature suggests there are some limits to this approach. Here we report a large retrospective study on agreement rate between ionized calcium (iCa) measurement and TCa or albumin-adjusted calcium measurements. Methods We retrospectively selected 5055 samples with simultaneous measurements of iCa, TCa, albumin and pH. We subgrouped our patients according to their estimated glomerular filtration rate (eGFR), albumin levels and pH. We analyzed each patient's calcium state with iCa as reference to determine agreement rate with TCa and albumin-adjusted calcium using Payne, Clase, Jain and Ridefelt formulas. Results The Payne formula performed poorly in patients with abnormal albumin, eGFR or pH levels. In patients with low albumin levels or blood pH disorders, Payne-adjusted calcium may overestimate the calcium state in up to 80% of cases. Similarly, TCa has better agreement with iCa in the case of hypoalbuminemia, but performed similarly to the Payne formula in patients with physiological albumin levels. The global agreement rate for Clase, Jain and Ridefelt formulas suggests significant improvement compared to Payne calcium adjustment but no significant improvement compared to TCa. Conclusions Total and albumin-adjusted calcium measurement leads to a misclassification of calcium status. Moreover, accurate calcium state determination depends on blood pH levels, whose measurement requires the same pre-analytical restrictions as iCa measurement. We propose that iCa should instead become the reference method to determine the real calcium state.

Evaluation of serum electrolytes measurement through the 6-year trueness verification program in China.

Objectives: The National Center for Clinical Laboratories (NCCL) in China initiated a serum electrolyte trueness verification (ETV) program in 2014 for measurement standardization. Methods: Every year, two levels of fresh frozen commutable serum samples determined by inductively coupled plasma mass spectrometry (ICP-MS) reference methods were transported to participating clinical laboratories for the measurement of sodium, potassium, calcium and magnesium. Both samples were measured 15 times in 3 days, and the mean values and coefficient variations (CVs) were calculated from the results. The tolerance limits of trueness (bias), precision (CV) and accuracy (TE) based on the biological variation database were used as the evaluation criteria. The overall trend of the ETV program over 6 years was surveyed by calculating the pass rates of the participating laboratories. The mean bias, inter-laboratory CV, and TE of all laboratory results were analysed. Furthermore, homogeneous and heterogeneous systems were compared, and the bias and CV results of mainstream analysis systems were analysed. Results: Pass rates of the three quality specifications increased, and the overall mean bias and inter-laboratory CVs decreased. The homogeneous system was superior to the heterogeneous system for calcium and magnesium measurements. For sodium, potassium, calcium and magnesium, the minimum bias corresponded to Hitachi, Siemens, Beckman AU and Roche, respectively. For inter-laboratory robust CVs, no obvious differences were observed between each peer group. Conclusions: The commutable ETV materials assigned via reference methods can evaluate the accuracy and reproducibility of an individual laboratory and the calibration traceability and uniformity between laboratories for measurements.

Ionophore-based ion-selective optical nanosensors operating in exhaustive sensing mode.

Ion selective optical sensors are typically interrogated under conditions where the sample concentration is not altered during measurement. We describe here an alternative exhaustive detection mode for ion selective optical sensors. This exhaustive sensor concept is demonstrated with ionophore-based nanooptodes either selective for calcium or the polycationic heparin antidote protamine. In agreement with a theoretical treatment presented here, linear calibration curves were obtained in the exhaustive detection mode instead of the sigmoidal curves for equilibrium-based sensors. The response range can be tuned by adjusting the nanosensor loading. The nanosensors showed average diameters of below 100 nm and the sensor response was found to be dramatically faster than that for film-based optodes. Due to the strong binding affinity of the exhaustive nanosensors, total calcium concentration in human blood plasma was successfully determined. Optical determination of protamine in human blood plasma using the exhaustive nanosensors was attempted, but was found to be less successful.

Candidate reference measurement procedures for chloride, potassium, sodium, calcium, magnesium, and lithium by inductively coupled plasma (isotope dilution) sector field mass spectrometry (ICP-(ID) SFMS) in serum.

BACKGROUND: Standardization of the measurement of electrolyte concentrations in serum is of considerable interest for quality assurance in patient care. To promote the ongoing process of standardization we developed candidate reference measurement procedures of highest metrological order for Cl, K, Na, Ca, Mg, and Li using ICP-(ID) SFMS. METHODS: Serum samples were diluted with 4 mmol/L nitric acid and were spiked with the internal standard for quantification, separately for each analyte. The samples were introduced in the ICP-SFMS device by continuous infusion using a peristaltic pump. The measurement results were compared with reference measurement procedure values obtained by atom absorption spectroscopy, flame emission spectroscopy, and coulometry. The measurement accuracy and precision was calculated by analyzing certified reference materials and EQAS samples. RESULTS: The mean coefficient of variation (CV) of the ICP-MS procedures for the serum samples was 0.65% for Cl, 0.46% for K, 0.51% for Na, 0.77% for Ca, 0.78% for Mg, and 0.58% for Li. The mean bias from target values of NIST certified reference materials was +0.85% for Cl, -0.46% for K, +0.68% for Na, -0.21% for Ca, +0.27% for Mg, and -0.39% for Li. CONCLUSIONS: Candidate reference measurement procedures for 6 electrolytes were developed by high performance magnetic sector field ICP-MS fulfilling the requirements of ISO 15193:2009 for reference measurement procedures with traceability to SI according to ISO 17511:2003 and can be used for setting target values in EQAS and for certification of reference materials.

Homogeneity and stability studies during the preparation of a laboratory reference material of soy leaves for the determination of metals.

The homogeneity and stability of metals were tested in a candidate laboratory reference material of soy leaves. Inductively coupled plasma-optical emission spectrometry was used to quantify calcium, magnesium, manganese, iron, zinc, copper, and vanadium. A 6 kg amount of the material, which was dried, ground, and classified as mesh 60, was distributed among 100 bottles. The between-bottle homogeneity test was established by analyzing two subsamples from nine bottles. For the within-bottle test, five determinations of each element of a single bottle were performed. The stability test was performed at temperatures of -10, +27, and +40 degrees C, and after storage times of 4, 12, 24, and 52 weeks. The obtained results indicated that the material was homogeneous and stable under the conditions studied.

Direct analysis of calcium in liquid infant formula via laser-induced breakdown spectroscopy (LIBS).

The present work illustrates the potential of laser-induced breakdown spectroscopy (LIBS) for the direct analysis of liquid food products. The aim of the experiment was to predict calcium content in ready-to-feed infant formula. The analysis was performed by a LIBS system coupled to a liquid sample chamber with a rotatory wheel that presents the liquid to the laser beam as a thin film. Multivariate analysis with partial least squares regression (PLSR) was performed to correlate LIBS spectral data to reference calcium contents. The obtained PLSR model exhibited a good fit and linearity, as indicated by the coefficients of determination for calibration (Rc2) and cross-validation (Rcv2), with values of 0.96 and 0.89, respectively. The robustness of the calibration model was assessed by external validation showing a root-mean-square error of prediction of 6.45 mg 100 mL-1. These results demonstrated the potential of LIBS for real-time analysis of liquid food products.

Determination of nickel, calcium and magnesium in xylem sap by flame atomic absorption spectrometry using a microsampling technique.

INTRODUCTION: Knowledge of xylem sap chemical composition is important to the understanding of translocation, detoxification and tolerance mechanisms. However, the small amount of sample available often hampers its characterisation. Hence, low volume consumption techniques are needed for xylem sap analysis. OBJECTIVE: To develop a microsampling technique for the determination of elements in xylem sap from different plants by flame atomic absorption spectrometry (FAAS). METHODOLOGY: The microsampling device was optimised in terms of sample volume and integration time. The analytical characteristics of the microsampling technique (micro-FAAS) were established and compared with those of FAAS with traditional continuous nebulisation. The method was validated by means of an independent technique. RESULTS: Ca, Mg and Ni were determined in a 50 microL aliquot of xylem sap solution/element that was introduced directly into the flame via the microsampling accessory. Good precision was obtained with relative standard deviations of 1.1, 0.6 and 2.3% for Ca, Mg and Ni, respectively. Matrix effects resulting from the physical characteristics of the samples and possible chemical interferences caused by phosphate and/or sulphate were ruled out. CONCLUSION: A simple, rapid and reproducible microsampling technique coupled to FAAS was developed and successfully applied in the determination of Ca, Mg and Ni in xylem sap.

Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND: Coronary artery calcium (CAC) has been demonstrated to be associated with the risk of coronary heart disease. The Multi-Ethnic Study of Atherosclerosis (MESA) provides a unique opportunity to examine the distribution of CAC on the basis of age, gender, and race/ethnicity in a cohort free of clinical cardiovascular disease and treated diabetes. METHODS AND RESULTS: MESA is a prospective cohort study designed to investigate subclinical cardiovascular disease in a multiethnic cohort free of clinical cardiovascular disease. The percentiles of the CAC distribution were estimated with nonparametric techniques. Treated diabetics were excluded from analysis. There were 6110 included in the analysis, with 53% female and an average age of 62 years. Men had greater calcium levels than women, and calcium amount and prevalence were steadily higher with increasing age. There were significant differences in calcium by race, and these associations differed across age and gender. For women, whites had the highest percentiles and Hispanics generally had the lowest; in the oldest age group, however, Chinese women had the lowest values. Overall, Chinese and black women were intermediate, with their order dependent on age. For men, whites consistently had the highest percentiles, and Hispanics had the second highest. Blacks were lowest at the younger ages, and Chinese were lowest at the older ages. At the MESA public website (http://www.mesa-nhlbi.org), an interactive form allows one to enter an age, gender, race/ethnicity, and CAC score to obtain a corresponding estimated percentile. CONCLUSIONS: The information provided here can be used to examine whether a patient has a high CAC score relative to others with the same age, gender, and race/ethnicity who do not have clinical cardiovascular disease or treated diabetes.

Bone health and adherence to vitamin D and calcium therapy in early breast cancer patients on endocrine therapy with aromatase inhibitors.

OBJECTIVES: Randomized trials involving aromatase inhibitors (AIs) in the adjuvant treatment of breast cancer patients have reported increased osteoporosis risk. Bone loss can be reduced with appropriate life style, vitamin D and calcium supplements, and with bisphosphonate therapy. The aim of this analysis was to investigate adherence to vitamin D and calcium in postmenopausal breast cancer patients receiving adjuvant non-steroidal AIs, and oncologists' adherence to the bone health guidelines. MATERIAL AND METHODS: This prospective study included 438 newly diagnosed patients and those who have already been receiving non-steroidal AIs for up to 3.5 years. Median endocrine therapy duration before recruitment in the study was 10.5 months (interquartile 4.8-26.6). RESULTS: Densitometry was performed on 142 patients (32.4%) before initiation of endocrine therapy, and on additional 38 (8.6%) patients at second study visit. Densitometry was not performed on 258 (59%) patients. Vitamin D and calcium were prescribed to 329/438 (75.1%) patients at some point during the study. Patients who took more than 80% of the prescribed dose were considered adherent. Self-reported adherence was 88.4%. Osteoporosis was diagnosed in 24 patients (5.5%) of the total study population, bearing in mind that 258/438 (59%) patients did not have densitometry. Bisphosphonates were prescribed to 54/438 (12.3%) patients, whilst only 19 (35.2%) of those had osteoporosis. CONCLUSION: In this analysis, lack of oncologists' adherence to the bone health guidelines was observed. In addition, a significant proportion of the patients did not adhere to the vitamin D and calcium.

Dietary supplements: What's in a name? What's in the bottle?

The Dietary Supplement Health and Education Act of 1994 (DSHEA), which arbitrarily classified herbals and other medicinal products as dietary supplements, obscured fundamental differences between two classes of products. Authentic supplements to the diet, such as multivitamins or calcium, have nutritional value and are safe. Herbals are used worldwide as medicines, they do not supplement the diet, they may cause severe adverse events, and they should be regulated as medicines. DSHEA also prevented the Food and Drug Administration (FDA) from effectively regulating herbal supplements as medicines. One consequence of weak FDA regulatory oversight is the poor quality of herbals. FDA inspections of manufacturing facilities have revealed violations of good manufacturing practices in over half of facilities inspected, including unsanitary conditions and lack of product specifications. Moreover, many "all natural" herbals marketed for weight loss, enhancement of sexual health and improving sports performance are adulterated with prescription and over-the-counter medications that have caused adverse cardiovascular events. New procedures to authenticate the identity of plants used in herbals will neither detect adulteration by medications nor provide assurance of appropriate pharmacological activity or safety. Nonvitamin, nonmineral "supplements" should be regulated as medicines, but revision or repeal of DSHEA faces strong opposition in Congress. The marketing of botanical supplements is based on unfounded claims that they are safe and effective. Health professionals need to inform patients and the public that there is no reason to take herbal medicines whose composition and benefits are unknown, and whose risks are evident.

Do we know the absolute values of intracellular free calcium concentration?

More than 20 years ago, it was shown that the addition of EGTA increases the affinity of the plasma membrane Ca2+ pump for Ca2+ by an order of magnitude. The left-hand shift of Ca2+-dependencies in the presence of EGTA has been also documented in studies of the sarcoplasmic reticulum Ca2+ pump, mitochondrial Ca2+-transporter as well as Ca2+-binding by calmodulin and troponin C. These data allow us to hypothesise that this effect is caused by an admixture of di- and trivalent cations possessing high affinity for EGTA and interacting with Ca2+-transporting and binding proteins. Here, we propose that polyvalent cations affect the estimation of absolute values of free intracellular Ca2+ concentration. Indeed, EGTA sharply increases the apparent affinity of the fluorescent Ca2+ indicators quin-2 and fluo-3 for Ca2+. The impact of polyvalent cations on Ca2+ measurement was further confirmed by the study showing the high sensitivity of Ca2+-induced fluo-3 fluorescence to Mn2+, Fe2+, Cu2+, and Co2+ seen in the absence of EGTA.

The aging process as a modifier of metabolism.

Because elderly adults have distinct metabolic characteristics that alter various nutrient requirements, simple extrapolations of nutrient requirements for younger adults are not warranted. Gastrointestinal function is well preserved with aging regarding the digestion and absorption of macronutrients, but the aging gastrointestinal tract becomes less efficient in absorbing vitamin B-12, vitamin D, and calcium. The new dietary reference intakes considered recent studies in aging adults and concluded that the recommended dietary allowances (RDAs) should be 1200 mg and 15 microg for calcium and vitamin D, respectively, for persons over the age of 70 y. The new RDAs for riboflavin, niacin, thiamine, folate, vitamin B-6, and vitamin B-12 are not different for persons in the oldest age category (>70 y) than for those aged 51-70 y. Because this is a quickly advancing field, it will be important to closely follow new research on nutrient requirements and aging over the next several years.

Calcium requirements of physically active people.

Dietary calcium and physical activity have been independently, but inconsistently, associated with the development of increased peak bone mass and reduced bone loss later in life. An examination of the literature points to important effects of dietary calcium on bone health. During the development of peak bone mass, calcium intakes of <1 g/d are associated with lower bone mineral density. At intakes approaching calcium requirements, physical activity is a more important predictor of bone mineral density than is calcium intake. In studies of postmenopausal women, calcium intakes of 1 g (25 mmol/d) appear to be necessary to effect a positive impact of exercise on bone mineral density in the spine. Calcium intakes recommended for protecting bone health appear to be adequate to protect against other disorders with an etiology that includes inadequate dietary calcium. Calcium requirements as modified by physical activity need to be determined for each population subgroup according to sex, age, race, and cultural environment.

Powders, composed of chlorine-releasing agent acrylic resin mixtures or based on peroxygen compounds, for spills of body fluids.

The use of powders, composed of a mixture of a chlorine-releasing agent with highly absorbent acrylic resin, for disinfecting body fluid spills was evaluated by laboratory tests. 'Encap' and 'Red Z' were found to absorb rapidly up to 200 ml of water to form a semi-solid gel. When experimental formulations containing 1%, 5% and 10% available chlorine were evaluated by a standardized surface test, those containing 10% gave the best results. The ease and rate of absorption of fluids by these formulations decreased as the fluid consistency increased and they seem more suitable for watery spills than for blood. The use of a powder based on peroxygen compounds ('Virkon') for disinfecting contaminated spills was evaluated by laboratory tests and hospital trials. Laboratory tests showed that 'Virkon' is strongly and rapidly bactericidal. In hospital ward trials by nurses using 'Virkon' on both natural and artificial spills, 60 of 62 contact plates pressed on to decontaminated surfaces proved negative, and no unpleasant fumes were generated when 'Virkon' was applied to urine. In another trial, 1% 'Virkon' solution proved very effective in decontaminating mortuary tables. Antiviral activity was not tested.

Adjustment of serum total calcium for albumin concentration: effects of non-linearity and of regression differences between laboratories.

It has been reported that the relationship between serum total calcium and albumin concentrations in hospital patients deviates from linearity at low albumin concentrations. We searched a large laboratory computer data base for adult patients with discretionary requests for serum calcium analysis but with no other data suggestive of disturbances of calcium homeostasis, and collected a minimum of 100 calcium values at each of a wide range of albumin concentrations. We confirmed the earlier observation, but found that the use of a single regression to derive an adjustment of total calcium for albumin gave only small differences of no clinical significance. To investigate whether equations to adjust total calcium for albumin can be transferred between laboratories, three laboratory computers were searched for calcium requests from patients likely to have a low prevalence of calcium disturbances. The regressions of total calcium on albumin differed significantly between laboratories, but within each laboratory gave adjusted calcium values identical with those in health. Although the errors resulting from applying an equation from one laboratory to another were small and unlikely to be of major clinical significance, we recommend that where possible laboratories should derive adjustment equations from their own data.

Adjustment of serum total calcium for albumin concentration: values change with age in women but not in men.

A total of 669 women and 609 men were selected from a laboratory computer data base in such a way that they would be expected to have a low prevalence of disturbances of calcium homeostasis but a wide range of serum albumin concentrations. The least squares regression coefficients of total calcium on albumin did not differ between men and women, nor did they differ at different ages. Mean serum albumin-adjusted calcium concentrations did not change with age in men from 1 to 90 years, and values were similar in women aged 1-20 years. However, adjusted calcium concentrations were significantly lower in women aged 21-50 and higher in women aged 61-90 than in younger women and all men. The differences were small and are unlikely to affect clinical interpretation.

[Nutritive value of daily food rations prepared in different regions of the country. III. The levels of calcium, phosphorus, magnesium, iron and potassium]. / Wartosc odzywcza calodziennych racji pokarmowych odtwarzanych w kilku regionach kraju. Cz. III. Zawartosc wapnia, fosforu, magnezu, zelaza i potasu.

Studies on the content of macrominerals in daily diets reconstructed in 1988 on the basis of the analysis of family budgets in 1986 carried out by the Central Statistical Bureau were carried on. Two social groups i.e. manual and mental workers with medium income were considered. The diets were prepared for 5 regions (Warszawa, Lublin, Olsztyn, Poznan, Wroclaw). According to the studies the requirements for calcium and magnesium were met in about 70% and those for iron in about 84%. The content of potassium in the diets was in the range of recommended allowances while the phosphorus exceeded the allowances by about 20-30%. The comparison of the presently studied diets with the ones from 1973, 1980, 1981 showed a lower degree of realization of the recommended intake of calcium and magnesium in 1986. The content of studied minerals in the diets was usually similar in all five regions.