- Diff Dx:
- factitious levels 2nd to
low protein and albumin (malabsorption, intestinal bypass surgery);
- causes related to calcium deficiency:
-
osteomalacia (most common)
- vitamin D defficiency;
-
rickets
- both vitamin D deficient rickets and vitamin dependent rickets may cause hypocalcemia;
- vitamin D resistant rickets usually does not cause hypocalcemia;
-
hypomagnesia:
- hypocalcemia can be caused by hypomagnesemia resulting from both an insufficient intake of magnesium
and magnesium wasting owing to diarrhea and thiazide therapy;
- causes related to excess of phosphorous:
- nephrotic syndrome (phosphate retention-hyperphospatemia)
- phosphorus ingestion
-
renal failure;
- tumor lysis
- massive tumor lysis results from the release of intracellular phosphate during massive cell destruction;
- commonly occurs during chemo for ALL in children;
- serum Pi levels typically rise within 1-2 days after initiating treatment;
- rising serum Pi concentration often is accompanied by hypocalcemia, hyperuricemia,
hyperkalemia, and renal failure;
- medullary Ca of thyroid
-
rhabdomyolysis (phosphate release);
- hypercalcemia may occur once the oliguric phase has ended;
-
hypoPTH
- acute pancreatitis
- alkalosis, hyperventilation
- vomiting:
-
hypo K &/or HypoMg will potentiate
hypoCa;
- medications:
- loop diuretics
- aminoglycosides
- dilantin;
Significance of hypocalcemia following hypovolemic shock.
Parathyroid response to hypocalcemia after treatment of hemorrhagic shock.
Ionized calcium and magnesium: the effect of septic shock in the baboon.
