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Hypocalcemia: Diff Dx

- 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.