Secondary Deficiency

Calcium absorption is impaired in achlorhydria, intestinal inflammation and any malabsorptive disorder accompanied by steatorrhoea (Wilson et al 1991). Increased faecal loss of calcium occurs with higher intakes of fibre and in fat malabsorption, while renal excretion has been shown in some studies to be increased in those patients ingesting a high protein diet (Kerstetter et al 1998).

Factors that compromise vitamin D status or activity will also affect calcium status (Pattanaungkul et al 2000, Prince et al 1997).

Other conditions that can predispose to hypocalcaemia include hypoparathyroidism (a deficiency in or absence of PTH), idiopathic hypoparathyroidism (an uncommon condition in which the parathyroid glands are Calcium 148

absent or atrophied), pseudohypoparathyroidism (characterised not by deficiency of

PTH, but by target organ resistance to its action), renal tubular disease, renal failure, magnesium depletion, acute pancreatitis, hypoproteinaemia, septic shock or the use of certain medicines such as anticonvulsants (phenytoin, phenobarbital) and rifampin, and both oral and inhaled corticosteroids, which alter vitamin D metabolism (Beers et al 2003, Rossi etal 2005).

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