Nephrology Book

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HypocalcemiaAka: Low Serum Calcium

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  1. Causes: Low Serum Calcium
    1. Renal insufficiency
    2. Hypoalbuminemia
    3. Vitamin D Deficiency
    4. Hypomagnesemia
    5. Pancreatitis
    6. PseudoHypoparathyroidism
    7. Sepsis
  2. Causes: Low Ionized Calcium
    1. Low Parathyroid Hormone
      1. Hypoparathyroidism
      2. Hypomagnesemia
    2. High Parathyroid Hormone
      1. Low serum phosphate
        1. Vitamin D Deficiency
        2. Pancreatitis
        3. Anticonvulsants
        4. Bisphosphonates
        5. Blood transfusion (related to citrate)
      2. High or normal serum phosphate
        1. Acute Renal Failure
        2. Rhabdomyolysis
        3. PseudoHypoparathyroidism
        4. Tumor lysis
  3. Symptoms
    1. Vomiting
    2. Diarrhea
    3. Nervousness
    4. Weakness
    5. Paresthesias
    6. Muscle stiffness and muscle cramps
    7. Headaches
    8. Dysphagia
    9. Abdominal Pain
  4. Signs
    1. Tetany
      1. Carpopedal Spasm (Trousseau's Sign)
      2. Chvostek's Sign
    2. Hair Loss
    3. Cataracts
    4. Papilledema
  5. Labs
    1. Total Serum Calcium low
    2. Ionized Calcium low
    3. Corrected Serum Calcium low
    4. Serum phophate high
    5. Parathyroid Hormone (PTH)
  6. Evaluation
    1. Use Corrected Serum Calcium (adjusts for Serum Albumin)
    2. Parathyroid Hormone (PTH) Low
      1. Hypoparathyroidism
    3. Parathyroid Hormone (PTH) High
      1. Pancreatitis
      2. Hyperphosphatemia
      3. Hypovitaminosis D
      4. PseudoHypoparathyroidism
      5. Medications
        1. Gentamycin
        2. cis-platinum
        3. Ethylene Glycol
        4. Colchicine
        5. EDTA
        6. Protamine
        7. Mithramycin
        8. Dilantin
        9. Phenobarbital
        10. Transfusion with citrated blood
  7. Management
    1. See Calcium Replacement

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