Which multifactorial causes are most clinically relevant in hypocalcemia emergencies?

Updated: Aug 08, 2019
  • Author: Manish Suneja, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Multifactorial causes are probably the most clinically relevant in hypocalcemic emergencies in the emergency department (ED). These include the following:

  • Rhabdomyolysis: increased phosphates from creatine phosphokinase (CPK) and other anions (ie, lactate, bicarbonate) chelate calcium

  • Toxic shock syndrome can cause hypocalcemia

  • High calcitonin levels cause low calcium

  • Malignancy: osteoblastic metastases (eg, breast cancer, prostate cancer) and tumor lysis syndrome may cause hypocalcemia (by differing mechanisms)

  • Infiltrative disease: sarcoidosis, tuberculosis, and hemochromatosis may infiltrate the parathyroids, causing dysfunction

  • Toxicologic causes include hydrofluoric acid burn or ingestion

  • Trauma patients with massive transfusion will have hemostasis impairment as one effect of hypocalcemia [28]

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