More than than the normal level of calcium in the blood causes hypercalcemia. Calcium is an essential mineral that helps in maintaining the bone health of our body. Calcium also plays an important role in releasing hormones, contracting the muscles, and in the proper functioning of nerves and brain. An overactive parathyroid gland may cause hypercalcemia as the gland regulates the calcium level in the body. Hypercalcemia may be caused due to cancer or other medical disorders.
Apart from the bones storing calcium, certain cells in the muscles and blood also store calcium. Green leafy vegetables, milk, cheese, etc supply the required calcium to the body. The body gets rid of the excess calcium into the urine thus maintaining normal level calcium in the blood. When the calcium level in the blood rises, the parathyroid glands release a hormone called calcitonin to balance the calcium. This balance gets disturbed in hypercalcemia.
Hypercalcemia can be diagnosed through blood tests, chest X-ray, CT scan, MRI scan, etc. Treatment would include drugs and dialysis depending on the severity of the condition. Drinking plenty of water can keep kidney stones away. Hypercalcemia can be caused due to overactive parathyroid glands, cancer, dehydration, increased levels of Vitamin D, dietary supplements, inherited kidney or metabolic conditions, infectious lung conditions and dehydration. Typical symptoms include muscle weakness, lethargy, confusion, muscle aches, frequent urination, thirst and abdominal pain.
The human body is composed of up to 60 % water. Adequate fluid and electrolyte levels are essential for healthy functioning of all organs and body systems. Electrolytes are found in the blood, urine, tissues and body fluids. Sodium, calcium, potassium, chlorine, phosphate and magnesium play an important role conducting electric charge within the body. These minerals must be maintained in the appropriate ratio for proper functioning of the muscles, nerves, brain and heart. If there is any imbalance in their ratio, which usually occurs due to change in water levels in the body, electrolyte imbalance will occur. The kidneys work as major regulators of the electrolyte balance. Kidney malfunction results in excessive electrolyte retention or excretion resulting in an imbalance.
Symptoms of electrolyte imbalance vary with the electrolyte. Typical symptoms of electrolyte imbalance include fatigue, dizziness, excessive sweating, cold extremities and trembling. Swelling in the feet, ankles, legs, and hands might also be due to a fluid and electrolyte imbalance. There might be nausea, reduced urine output, dark urine, dry skin, aching joints and dry mouth. In cases of severe electrolyte imbalance, there might be convulsions and seizures.
Urine test and blood tests are done to evaluate the electrolyte imbalance. Often kidney ultrasound or EKG might be ordered. Based on the electrolyte that is out of balance, treatment includes dietary changes, fluid intake restrictions and medications to correct the imbalance. Often medication like corticosteroids, laxatives, cough medicines, diuretics and oral contraceptives can cause changes in the electrolyte balance.
Hyponatremia: Imbalance in sodium concentration in the plasma.
Hypokalemiaa: Deficiency of potassium in the bloodstream.
Hypercalcemia: Elevated calcium level in the blood.
When deep slumber at night is regularly disrupted by an urgent feeling of urination, it is a condition called nocturia. It is common in older adults, both men and women, usually in the age group of 55 and 84 years. Nocturia is different from enuresis or bed-wetting wherein the person does not wake up from sleep but involuntarily empties the bladder. Nocturia affected person experiences sleep loss due to an urgent need to urinate. Mild nocturia is characterized by a need to urinate two to three times and in severe cases it can be anywhere between five to six times on a particular night, occasionally or daily.
Nocturia types and causes
Besides the normal aging process, nocturia is also linked to other causes. In women, besides age, childbirth or pelvic organ prolapse and menopause are often contributing factors to nocturia.
There is an overproduction of urine at night. In a 24-hour cycle the urine volume may be greater than 40 ml/kg or if the volume of urine passed at night exceeds one-third of the total daily urine output. The main feature of nocturnal polyuria is that more urine is produced during sleep which in turn induces more nighttime urination.
All fluids or even certain foods like salads, vegetables, fruits, rice and pasta with high water content can cause nocturnal polyuria. Diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive Vitamin D medication can lead to frequent urination. Ankle swelling is another common cause of nocturnal polyuria. Congestive heart failure, venous stasis, hypoalbuminemia or excessive salt intake are other causes for fluid retention.
In adults, the normal urine production is 1 to 2 liters. Polyuria is characterized by urine output that exceeds 2500 ml/24 hours during the day as well as at night. Polyuria is common in people with diabetes mellitus and diabetes insipidus. Other conditions causing polyuria are Polycystic kidney disease, Sickle cell disease, Pyelonephritis, Amyloidosis, Sjogren syndrome and Myeloma. Vascular disease, restless leg syndrome, thyroid disorder and congestive heart failure are some causes for increased urinary output at night by the kidneys. Polydispisia or excessive thirst that compels drinking lots of water can cause polyuria. The thirst center or hypothalamus is affected due to anxiety, stress or psychiatric illness and leads to excessive thirst. Intravenous saline drip excessively administered can lead to polyuria. Hypercalcemia and hypokalemia lead to abnormal levels of electrolytes that can result in excessive urination.
Inadequate bladder storage
The urinary bladder has the capacity to hold as much as 600 ml of urine. But the desire to urinate is experienced when the level reaches about 150 ml. There are various reasons and conditions that lead to inadequate bladder storage. Bladder obstruction, bladder infection or recurrent urinary tract infection, bladder inflammation, pain in the bladder, bladder cancer can reduce bladder storage capacity. Stroke and Parkinson's disease can also lead to reduction in its storage capacity thus inducing an urgent need to empty the bladder.
A combination of nocturnal polyuria with reduced bladder capacity is termed as mixed nocturia.
Diagnosis of Nocturia
Basic diagnostic procedure is to record the frequency, volume and timing both daytime and nighttime for a minimum of 1-3 days. Certain diagnostic tests like urine analysis, urine culture or an ultrasound are done. Accordingly, the treatment procedure is determined. Treatment options include making dietary changes, behavioral changes with a combination of medications.
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Bibliography / Reference
Collection of Pages - Last revised Date: December 8, 2023