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Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Aspirin inhibits thromboxane A2 (TXA2) production by platelets, thereby increasing prostacyclin/TXA2 ratio and reducing platelet aggregation and, therefore, protects against vasoconstriction and pathological blood coagulation in the placenta. It is recommended that aspirin should be commenced at a dose of 150 mg/day in women with at least one major high-risk factor or two moderate high-risk factors for pre-eclampsia ideally before 16 weeks and definitely before 20 weeks of gestation, and continued until delivery to reduce the risk of pre-eclampsia. The number needed to treat is approximately 70. It is also recommended to administer calcium at a dose of 1.2–2.5 g/day if a pregnant woman’s daily consumption of calcium is low or if it cannot be assessed. Calcium supplements are unnecessary if dietary calcium intake is adequate. Administration of low molecular weight heparin or the vitamins C, E or D, is not recommended. General measures such as exercise should be encouraged to maintain health and appropriate body weight as well as to reduce the likelihood of developing hypertension. If a woman’s BP is consistently >140/90 mmHg, then she should be treated with oral methyldopa, labetalol, oxprenolol or nifedipine to decrease the likelihood of developing severe maternal hypertension and other complications. However, the BP should not be allowed to fall below 130/80 mmHg.
Clinical Chemistry
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
Calcium supplements: Calcium gluconate (IV) – use cardiac monitorCalcium carbonate (PO)
Treating the Dysmetabolism Underlying Osteoporosis
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
The Institute of Medicine recommends as the recommended dietary allowances for calcium; 1300 mg daily for children ages 9–18 years old; 1,000 mg for men ages 19–70 years old and women ages 19–50 years old; and 1,200 mg for men ages >70 years old and women ages >50 years old [10]. Dietary sources are still considered the best, though the standard diet of western commerce generally falls far short of supplying adequate calcium. In comparing the amount of elementary calcium in the most common calcium preparations, calcium carbonate (40%) and calcium phosphate (21%) have the highest amounts. Calcium citrate has been reported to have slightly higher absorption than calcium carbonate, especially when taken on an empty stomach [130], although other studies have shown that they are of equal bioavailability [131]. The literature supports up to 1800 mg daily for patients who are actively losing weight and for patients who have undergone bariatric surgery [132, 133]. However, there have been recent concerns about possible over supplementation of calcium with an increased risk of cardiovascular disease, therefore, emphasizing the importance of dietary calcium intake and evidence-based use of calcium supplements in the appropriate patients [134].
Bone-friendly lifestyle and the role of calcium or vitamin D supplementation
Published in Climacteric, 2022
Non-pharmaceutical recommendations for optimization of bone health are as follows:Do not smoke.Limit alcohol intake to ≤2 alcoholic drinks daily.Maintain a healthy body weight (i.e. BMI of about 25 kg/m2).Take a balanced diet with adequate contents of protein (i.e. about 1 g/kg/day) and calcium (>500 mg/day, i.e. two servings of dairy products or equivalent).In those with poor sunlight exposure, consider use of a vitamin D supplement of 400–1000 IU/day.Calcium supplements cause side effects and are of unproven value. Their use is discouraged.
Management of age-associated medical complications in patients with β-thalassemia
Published in Expert Review of Hematology, 2020
Irene Motta, Marta Mancarella, Alessia Marcon, Marco Vicenzi, Maria Domenica Cappellini
Supplementation of vitamin D and calcium and bisphosphonates therapy are the most prescribed treatments for patients with thalassemic bone disease. Vitamin D supplementation is recommended when 25OHvitD serum levels are <20 ng/mL. The replacement dose prescribed in the patients with deficiency is generally 800 IU/day, as usually recommended to the non-thalassemic individuals [69]. Calcium supplements are recommended for the patients who are unable to meet the recommended daily calcium intake levels from the diet as well as in case of the patients for whom the supplements are an adjunct to bone-specific treatment. Bisphosphonates (oral or intravenous) represent the most widely used agents in the treatment of osteoporosis [70–72], owing to their ability to decrease bone resorption and improve BMD in the patients with TDT and NTDT. Oral alendronate, intravenous (IV) neridronate, IV zoledronic acid, and clodronate (IV and intramuscular) have been evaluated against placebo or no therapy in the subjects with thalassemia-associated osteoporosis. Zoledronic acid and neridronate have also been reported to be able to reduce bone and back pains.
Calcium Supplementation and Coronary Artery Disease: A Methodological Confound?
Published in Journal of the American College of Nutrition, 2020
Taylor C. Wallace, Connie M. Weaver
Tissues sense diet-induced changes in serum nutrient concentrations or in hormonal factors altered by the diet, but not the source of a nutrient (dietary or supplemental). Calcium supplements typically constitute either carbonate or citrate salts, with phosphate, hydroxide and other anions representing a minor fraction of the products on the market. These calcium salts are fortified into many staple food products (e.g., orange juice, milk-alternatives and cereal) which have not been shown to exert any detrimental effects regarding CVD risk. Meeting calcium requirements from the diet is prudent since many other nutrients and dietary bioactive compounds are also present in the food matrix. Dairy products provide most of the calcium in the diet. Few calcium fortified foods provide similar bioavailable forms of calcium in amounts that can serve as alternatives to dairy.(52) The Dietary Guidelines for Americans recommend 3 servings/d of low or nonfat dairy products or dairy alternatives.(53) For every absent serving supplementation with 300 of calcium is advised to meet recommended intakes.(54) The hypothesis that calcium supplements may have a causal inference on cardiovascular events is founded upon a small portion of secondary analyses of RCTs and observational analyses lacking appropriate primary outcome measures, consideration of kidney function and other potential confounders as covariates, and a small number of events mostly self-reported and non-adjudicated. More importantly, the hypothesis currently lacks biological plausibility and is likely a methodological Confound.