Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19

[youngsinatra]

I am currently at home, because I got tested positive for COVID thrice lately and I was curious if there is a connection between COVID-19 severity and calcium metabolism (PTH, vitamin D, serum calcium, phosphate) and it turns out that there is something!

"In a large group of SARS patients in North America, hypocalcemia was detected in 60% of patients at hospital admission and in 70% during hospitalization [6]. Moreover, data from patients with Ebolavirus infection in United States and European hospitals reported a similar incidence of hypocalcemia [7]."
- Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19

"Few mechanisms which explain the causes of hypocalcaemia in COVID-19 have been discussed, such as vitamin D deficiency, hypoalbuminemia, impaired intestinal absorption of calcium, hypoxic tissue damage with subsequent increase in calcium influx and impaired secretion of and response to parathyroid hormone (PTH) secondary to increased levels of inflammatory cytokines"

"To date, little is known about the effect of the novel coronavirus (SARS-CoV-2) on parathyroid glands. Elkattawy et al. reported a 46-year-old patient admitted with severe COVID-19 infection and had a prolonged hospital stay. His laboratory workup showed hyperphosphatemia and low parathyroid hormone level. All possible causes of hypoparathyroidism have been excluded. To the best of our knowledge, this is the first and the only report in the literature so far which stated that COVID-19 can be considered as a possible direct cause of hypoparathyroidism [2]. Because of the limited data which link between SARS-CoV-2 and parathyroid glands, going back to the studies which were conducted on the previous generation of coronavirus (SARS-CoV), the culprit of severe acute respiratory syndrome (SARS) epidemic in 2003, could improve our understanding of this topic. Tissue samples taken from patients died of SARS identified SARS-CoV RNA and antigenic materials in parathyroid gland acidophilic cells [3]. In addition, Increased expression levels of angiotensin converting enzyme 2 (ACE2) receptors were detected in acidophilic cells of parathyroid glands [4]. Therefore, SARS-CoV-2 might have the potential to directly invade the parathyroid glands by binding with acidophilic cells ACE2 receptors. This could explain the finding of hypoparathyroidism in the COVID-19 patient reported by Elkattawy et al."

- The effect of COVID-19 on parathyroid glands

There are also some papers that show that PTH secretion is impaired in COVID-19 and thus causing hypocalcemia. Maybe some more clues why vitamin D (and dietary calcium) may be so protective against COVID-19 severity.

 

[brocktoon]

I am currently at home, because I got tested positive for COVID thrice lately and I was curious if there is a connection between COVID-19 severity and calcium metabolism (PTH, vitamin D, serum calcium, phosphate) and it turns out that there is something!

"In a large group of SARS patients in North America, hypocalcemia was detected in 60% of patients at hospital admission and in 70% during hospitalization [6]. Moreover, data from patients with Ebolavirus infection in United States and European hospitals reported a similar incidence of hypocalcemia [7]."
- Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19

"Few mechanisms which explain the causes of hypocalcaemia in COVID-19 have been discussed, such as vitamin D deficiency, hypoalbuminemia, impaired intestinal absorption of calcium, hypoxic tissue damage with subsequent increase in calcium influx and impaired secretion of and response to parathyroid hormone (PTH) secondary to increased levels of inflammatory cytokines"

"To date, little is known about the effect of the novel coronavirus (SARS-CoV-2) on parathyroid glands. Elkattawy et al. reported a 46-year-old patient admitted with severe COVID-19 infection and had a prolonged hospital stay. His laboratory workup showed hyperphosphatemia and low parathyroid hormone level. All possible causes of hypoparathyroidism have been excluded. To the best of our knowledge, this is the first and the only report in the literature so far which stated that COVID-19 can be considered as a possible direct cause of hypoparathyroidism [2]. Because of the limited data which link between SARS-CoV-2 and parathyroid glands, going back to the studies which were conducted on the previous generation of coronavirus (SARS-CoV), the culprit of severe acute respiratory syndrome (SARS) epidemic in 2003, could improve our understanding of this topic. Tissue samples taken from patients died of SARS identified SARS-CoV RNA and antigenic materials in parathyroid gland acidophilic cells [3]. In addition, Increased expression levels of angiotensin converting enzyme 2 (ACE2) receptors were detected in acidophilic cells of parathyroid glands [4]. Therefore, SARS-CoV-2 might have the potential to directly invade the parathyroid glands by binding with acidophilic cells ACE2 receptors. This could explain the finding of hypoparathyroidism in the COVID-19 patient reported by Elkattawy et al."

- The effect of COVID-19 on parathyroid glands

There are also some papers that show that PTH secretion is impaired in COVID-19 and thus causing hypocalcemia. Maybe some more clues why vitamin D (and dietary calcium) may be so protective against COVID-19 severity.

Good stuff, thanks. Be well.

 

[Mauritio]

Thanks for sharing , very interesting.

There are also some papers that show that PTH secretion is impaired in COVID-19

Do you have a source for that?
I would have thought that covid 19 patients had low calcium and high PTH , which would explain why vitamin D is so effective at treating it ,since it lowers PTH.

 

[youngsinatra]

Thanks for sharing , very interesting.
Do you have a source for that?
I would have thought that covid 19 patients had low calcium and high PTH , which would explain why vitamin D is so effective at treating it ,since it lowers PTH.

You can read it in the paper directly. PTH should normally raise the low serum calcium, but it seems that PTH secretion is suppressed by COVID and this could lead to hypocalcemia, especially when vitamin D is low and calcium intake is low too.

Maybe the endogenous regulation of calcium is tweaked by the infection and supplying dietary calcium and vitamin D becomes even more important for preventing hypocalcemia. But I am too uneducated on the matter, and even the paper said that this connection with low PTH is relatively new in the context of COVID.

 

[Mauritio]

You can read it in the paper directly. PTH should normally raise the low serum calcium, but it seems that PTH secretion is suppressed by COVID and this could lead to hypocalcemia, especially when vitamin D is low and calcium intake is low too.

Maybe the endogenous regulation of calcium is tweaked by the infection and supplying dietary calcium and vitamin D becomes even more important for preventing hypocalcemia. But I am too uneducated on the matter, and even the paper said that this connection with low PTH is relatively new in the context of COVID.

From the part you posted it seems like it's just hypothesis they discuss. I think it's unlikely that they have low PTH, especially since it's been shown that they almost all have low vitamin D levels.

 

[youngsinatra]

From the part you posted it seems like it's just hypothesis they discuss. I think it's unlikely that they have low PTH, especially since it's been shown that they almost all have low vitamin D levels.

Shouldn't high PTH then lead to normal or even high serum calcium?

 

[Mauritio]

Shouldn't high PTH then lead to normal or even high serum calcium?

PTH can even cause hypercalcemia. But it is definitely not the only factor influencing calcium levels.
If it was the only factor sick, stressed people all had low PTH levels since : PTH increases calcium, which lowers PTH .
But even if that takes place you still got cortisol,estrogen, serotonin, aldosterone increasing PTH and vice versa .

I think it all comes down to the self reinforcing stress metabolism and if some things are strong enough to brake this cycle (vitamin D +k , magnesium, progesterone, etc...)

PTH - the connection of all stress hormones

"When there is adequate calcium, vitamin D, and magnesium in the diet, PTH is kept to a minimum. When PTH is kept low, cells increase their formation of the uncoupling proteins, that cause mitochondria to use energy at a higher rate, and this is associated with decreased activity of the fatty...

raypeatforum.com

 

[Mauritio]

"Calcium metabolism is controlled primarily by parathyroid and ultimobranchial
derivatives (Section IV), but is influenced by both the thyroid and the thymus."

"...thymectomy removes a physiological brake on parathyroid hormone secretion. It has been proposed that the greater tendency for older individuals to develop hypercalcemia under cer-
tain conditions can be related to smaller
thymus glands."

TEXTBOOK OF ENDOCRINE PHYSIOLOGY
Constance R. Martin, Ph.D.

 

[Jam]

Mortality From Coronavirus Disease 2019 Increases With Unsaturated Fat and May Be Reduced by Early Calcium and Albumin Supplementation

Mortality From Coronavirus Disease 2019 Increases With Unsaturated Fat and May Be Reduced by Early Calcium and Albumin Supplementation What You Need to Know Background and context While most COVID-19 patients clear the infection, some develop severe disease with organ failure. Based on patterns...

raypeatforum.com

 

[Epik]

Apparently, SARS-CoV-2 requires a calcium rich environment. It's stated in the video at 16:14

View: https://youtu.be/6DxlkxA82FM


I feel like this has to do with why PTH, vitamin D3 and calcium is so important to consider.

 

[Gustav3Y]

For a certain family member a bit older, the PTH is above lab values around 100% more, not eating any big calcium foods, the serum calcium is always constant and good when tested.
Vitamin D is fluctuating from very low to low for them.
Barely eats food in the last 2-3years.

They had the disease already almost a year ago, it was very mild as it has been told to me.

 

[Recoen]

If you look at the pth issue from a Ling perspective - so Ca oscillations are inhibited, extracellular Ca and Na stay in the cell where the intracellular Mg and K leave - this can explain why one would have high pth and Hypocalcemia.