Calcium Abnormalities

• Hypercalcemia is defined as an adjusted calcium level >2.6 mmol/L
• Causes of hypercalcemia:

  • Hyperparathyroidism
  • Malignant tumor - specifically ones that release PTHrP
  • Vitamin D intoxication
  • Thiazide diuretics
• Symptoms of hypercalcemia:

  • Kidney stones
  • Polyuria
  • Polydipsia
  • Abdominal pain
  • Constipation
  • Mental status changes
• In severe hypercalcemia a shortened QT interval is shown on ECG, and arrhythmias may occur, particularly in patients taking digoxin.
• Hypocalcaemia is defined as an adjusted calcium level of<2.2 mmol/L.
• Hypercalcemia management:

  • Rehydration
  • Bisphosphonates
• Clinical features of hypocalcemia:

  • Tetany
  • Perioral paresthesia
  • Depression
  • Cataracts
  • ECG: Prolonged QT interval
  • Trousseau's sign
  • Chvostek's sign
• Management of hypocalcemia:

  • Severe hypocalcemia requires IV calcium replacement
  • Further management depends on underlying cause
• Causes of hypocalcemia:

  • Vitamin D deficiency
  • Chronic kidney disease
  • Hypoparathyroidism
  • Pseudohypoparathyroidism
  • Rhabdomyolysis
  • Magnesium deficiency
  • Massive blood transfusion
  • Acute pancreatitis