Calcium Abnormalities in Hospitalized Patients

Abstract

Depending upon the method of measurement, hypocalcemia occurs in 15% to 88% and hypercalcemia occurs in 15% of hospitalized patients. Ionized calcium should be measured in place of total serum calcium to avoid errors related to hypoalbuminemia, which is seen commonly in acutely ill patients. Symptomatic hypocalcemia requires prompt intravenous calcium administration. Symptomatic hypercalcemia (most often caused by hyperparathyroidism or malignancy) warrants aggressive intravenous hydration to correct volume depletion and, usually, additional therapy with diuretics, bisphosphonates, calcitonin, or corticosteroids. Identification and treatment of the underlying cause of the calcium derangement must be addressed after the acute electrolyte abnormality is stabilized.

Phosphorus and Calcium

“…The goals of therapy should include returning the serum [P] to normal (eg, 2.7-4.5 mg/dL [~0.9-1.45 mmol/L]), avoiding or resolving symptoms of hyperphosphatemia, and possibly maintaining the serum Ca-P product <55 mg 2 /dL 2 . 40,85,86 Hypocalcemia Hypocalcemia (total serum [Ca] <8.6 mg/dL [~2.15 mmol/L], ionized [Ca] <1.1 mmol/L) has been reported in approximately 15%-88% of hospitalized adult patients, 90 and one study observed hypocalcemia in approximately 21% of critically ill trauma patients. 25 Hypocalcemia is often associated with hypoalbuminemia in hospitalized patients, but other causes can include sepsis, pancreatitis, renal insufficiency, hypoparathyroidism, administration of blood preserved with citrate, hypomagnesaemia, and hyperphosphatemia.…”

“…2,24 Magnesium deficiency may impair PTH release and/or activity and contribute to hypocalcemia. 4,[90][91][92] The hallmark sign of severe acute hypocalcemia is tetany, but other neuromuscular, cardiovascular, and central nervous [93][94][95][96] It would be prudent to establish a standardized method for ordering Ca supplementation to minimize the risk of errors. [97][98][99] This approach should include using Ca gluconate as the preferred salt for routine Ca maintenance dosing and supplementation and restricting Ca chloride for use in urgent and emergent situations.…”

A Hypercalcemic Patient With Malignancy, Hyperparathyroidism, Hypercalciuria and Vitamin D Overdose; Management and Brief Literature Review

“…As with the current case, treatment with saline solution may suffice for correcting hypercalcemia along with treatment of the underlying etiological factors without further medication (2,3). However, such therapeutic modalities as loop diuretics, biphosphonates, calcitonin, glucocorticoids, and hemodialysis should be added in the patents not responding to effective hydration.…”

“…Hypercalcemia is a laboratory finding of a wide variety of conditions. Primary hyperparathyroidism (50%) and hypercalcemia associated with malignancies (30-40%) constitute about 90% of all hypercalcemias (2,3). The remaining 10% of hypercalcemias are caused by granulomatous diseases, several drugs (thiazide diuretics, lithium, vitamins D and A, aluminum intoxication), endocrine disorders such as thyrotoxicosis, pheochromocytoma, and adrenal insufficiency, and other rarer diseases like familial hypocalciuric hypercalcemia (2).…”

A dangerous mixture

“…Among the major causes of hypocalcemia, only vitamin D deficiency emerged. [13][14][15] Regarding other possible causes of hypocalcemia, our patient never received diuretic therapy; massive intestinal loss of electrolytes was excluded because Emilia had occasional constipation, which she resolved taking small amounts of herbal products; anti-transglutaminase antibodies were absent. She never presented pancreas nor kidney disease except a slightly increase in urinary protein excretion, and phosphatemia was normal.…”