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{{Hypocalcemia}}
{{Hypocalcemia}}
{{CMG}}
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==Overview==
[[Hypocalcemia]] can be the consequence of multiple disease processes, some of which will be mentioned in the following discussion. Common causes of hypocalcemia include [[Vitamin D deficiency|vitamin D insufficiency]], [[hypoparathyroidism]], [[renal]] disease, [[pseudohypoparathyroidism]], [[hypomagnesemia]], drugs and [[Fanconi syndrome]] etc.


==Causes==
==Causes==
===Common Causes===
===Common Causes===
Hypocalcemia can be the consequence of multiple disease processes, some of which will be mentioned in the following discussion. The most common cause is the inability to mobilize calcium from bone which is primarily induced by decreased levels of the parathyroid hormone (PTH) due to derangement of the parathyroid gland function (ie, the gland responsible of calcium homeostasis) or vitamin D deficiency.
Common causes of [[hypocalcemia]] may include:<ref name="pmid22439169">{{cite journal |vauthors=Fong J, Khan A |title=Hypocalcemia: updates in diagnosis and management for primary care |journal=Can Fam Physician |volume=58 |issue=2 |pages=158–62 |date=February 2012 |pmid=22439169 |pmc=3279267 |doi= |url=}}</ref>
* Hypoparathyroidism: It signifies diminished activity of the parathyroid gland due to multiple reasons: autoimmune destruction (included in the polyglandular autoimmune syndrome type I), resection of the glands as a possible complication of total thyroidectomy or genetic diseases affecting the gland's function. A second entity that should be mentioned is pseudohypoparathyroidism which is characterized by normal gland function but inability of the PTH-target organs (bone and kidney) to respond to PTH. Patients present with hypocalcemia but high PTH levels.
* [[Vitamin D]] insufficiency
* [[Hypoparathyroidism]]
* [[Renal]] disease
* [[Pseudohypoparathyroidism]] 
* Drugs like [[bisphosphonates]]
* Heavy metal ([[copper]], [[iron]])
 
=== Less Common Causes ===
Lessn common causes of [[hypocalcemia]] may include:<ref name="pmid224391692">{{cite journal |vauthors=Fong J, Khan A |title=Hypocalcemia: updates in diagnosis and management for primary care |journal=Can Fam Physician |volume=58 |issue=2 |pages=158–62 |date=February 2012 |pmid=22439169 |pmc=3279267 |doi= |url=}}</ref>
* [[Hypomagnesemia]] 
* [[Citrate|Citrated]] [[blood transfusions]]
* [[Fanconi syndrome]]
* [[Radiation]] 


===Causes by Organ System===
===Causes by Organ System===
 
{| style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Alcohol abuse]]
| bgcolor="Beige" | [[Alcohol abuse]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Anticonvulsant]] therapy, [[Chelation]] therapy, [[Cinacalcet]], [[Cytarabine]], [[Dactinomycin]], [[Diuretic]] therapy, [[Drugs]], [[Enemas]], [[Gentamicin]], [[laxative]]s, [[Medroxyprogesterone]], [[Nilotinib]], [[Oxcarbazepine]], [[Pentamidine Isethionate]], [[Pramipexole]], [[Sorafenib]], [[Steroid]], [[Thalidomide]], [[Tolbutamide]] therapy
| bgcolor="Beige" | [[Anticonvulsant]] therapy, [[Cabozantinib]], [[Capreomycin sulfate]], [[Chelation]] therapy, [[Cinacalcet]], [[Conjugated estrogens/bazedoxifene]], [[Cytarabine]], [[Dactinomycin]], [[Diuretic]] therapy, [[Drugs]], [[Edetate disodium]], [[Enemas]],  [[Gallium nitrate]], [[Gentamicin]],  [[ibandronate]], [[laxative]]s, [[Medroxyprogesterone]], [[Nilotinib]], [[Oxcarbazepine]], [[Pamidronic acid]], [[Pentamidine Isethionate]], [[Pramipexole]], [[Sorafenib]], [[Steroid]], [[Thalidomide]], [[Tolbutamide]] therapy
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| Absent [[parathyroid hormone]] (PTH), Acquired [[hypoparathyroidism]], [[Adrenocortical hyperplasia]], Deficient [[PTH]], Excessive secretion of calcitonin, [[Familial hypocalcemia]], Following [[thyroidectomy]], Hereditary [[hypoparathyroidism]], "Hungry Bone Syndrome" following [[parathyroidectomy]], [[Hypoparathyroidism]], [[Hypoproteinemia]], [[Medullary carcinoma of the thyroid]], [[Osteitis fibrosa]] following [[parathyroidectomy]], [[Osteoporosis]], [[Pseudohypoparathyroidism]], [[Thyroid cancer]]
| bgcolor="Beige" | Absent [[parathyroid hormone]] (PTH), Acquired [[hypoparathyroidism]], [[Adrenocortical hyperplasia]], Deficient [[PTH]], Excessive secretion of calcitonin, [[Familial hypocalcemia]], Following [[thyroidectomy]], Hereditary [[hypoparathyroidism]], "Hungry Bone Syndrome" following [[parathyroidectomy]], [[Hypoparathyroidism]], [[Hypoproteinemia]], [[Medullary carcinoma of the thyroid]], [[Osteitis fibrosa]] following [[parathyroidectomy]], [[Osteoporosis]], [[Pseudohypoparathyroidism]], [[Thyroid cancer]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| Decreased [[ultraviolet]]/sun ([[vitamin D deficiency]]), Defective [[Vitamin D]] metabolism, Exposure to [[hydrofluoric acid]]
| bgcolor="Beige" | Decreased [[ultraviolet]]/sun ([[vitamin D deficiency]]), Defective [[Vitamin D]] metabolism, Exposure to [[hydrofluoric acid]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute pancreatitis]], [[Cirrhosis]], Decreased dietary intake, [[Eating disorders]], [[Enemas]], [[laxative]]s, Intestinal [[malabsorption]], [[Malabsorption]], Mal[[digestion]], [[Pancreatitis]], [[Rickets]], [[Short bowel syndrome]], Vitamin-D dependent [[rickets]], type I
| bgcolor="Beige" | [[Acute pancreatitis]], [[Cirrhosis]], Decreased dietary intake, [[Eating disorders]], [[Enemas]], [[laxative]]s, Intestinal [[malabsorption]], [[Malabsorption]], Mal[[digestion]], [[Pancreatitis]], [[Rickets]], [[Short bowel syndrome]], Vitamin-D dependent [[rickets]], type I
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[DiGeorge's Syndrome]], [[Familial hypocalcemia]]
| bgcolor="Beige" | [[DiGeorge's Syndrome]], [[Familial hypocalcemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| [[Hypoalbuminemia]] (pseudohypocalcemia), [[Transfusion]] of citrated blood, [[Tumor lysis syndrome]]
| bgcolor="Beige" | [[Hypoalbuminemia]] (pseudohypocalcemia), [[Transfusion]] of citrated blood, [[Tumor lysis syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Sepsis]], [[Septic shock]]
| bgcolor="Beige" | [[Sepsis]], [[Septic shock]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| Enhanced [[bone]] formation, Excessive secretion of calcitonin, Neonatal [[tetany]], [[Osteitis fibrosa]] following [[parathyroidectomy]], [[Osteoporosis]], [[Rickets]], Vitamin-D dependent [[rickets]], type I
| bgcolor="Beige" | Enhanced [[bone]] formation, Excessive secretion of calcitonin, Neonatal [[tetany]], [[Osteitis fibrosa]] following [[parathyroidectomy]], [[Osteoporosis]], [[Rickets]], Vitamin-D dependent [[rickets]], type I
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| Absent active [[vitamin D]], Decreased dietary intake, [[Hyperphosphatemia]], Intestinal [[malabsorption]], Intravenous phosphate administration, [[Magnesium]] depletion, [[Rickets]], [[Vitamin D deficiency]]
| bgcolor="Beige" | Absent active [[vitamin D]], Decreased dietary intake, [[Hyperphosphatemia]], Intestinal [[malabsorption]], Intravenous phosphate administration, [[Magnesium]] depletion, [[Rickets]], [[Vitamin D deficiency]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Breast cancer]]
| bgcolor="Beige" | [[Breast cancer]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[Breast cancer]], [[Bronchial cancer]], [[Medullary carcinoma of the thyroid]], Osteoblastic metastases, [[Thyroid cancer]], [[Tumor lysis syndrome]]
| bgcolor="Beige" | [[Breast cancer]], [[Bronchial cancer]], [[Medullary carcinoma of the thyroid]], Osteoblastic metastases, [[Thyroid cancer]], [[Tumor lysis syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Magnesium]] over supplementation, Prolonged use of medications/laxatives containing [[magnesium]]
| bgcolor="Beige" | [[Magnesium]] over supplementation, Prolonged use of medications/laxatives containing [[magnesium]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| [[Eating disorders]]
| bgcolor="Beige" | [[Eating disorders]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| [[Bronchial cancer]], [[Hyperventilation]]
| bgcolor="Beige" | [[Bronchial cancer]], [[Hyperventilation]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acute renal failure]], [[Alkalosis]], [[Chronic renal failure]], [[Hypomagnesemia]], [[Hypoproteinemia]], Increased [[diuresis]] with physiologic saline solution, Intravenous phosphate administration, Kidney diseases with reduced formation of activated [[vitamin D]], [[Magnesium]] depletion, [[Magnesium]] over supplementation, [[Nephrotic syndrome]], [[Renal failure]], [[Rhabdomyolysis]], Severe acute [[hyperphosphatemia]]
| bgcolor="Beige" | [[Acute renal failure]], [[Alkalosis]], [[Chronic renal failure]], [[Hypomagnesemia]], [[Hypoproteinemia]], Increased [[diuresis]] with physiologic saline solution, Intravenous phosphate administration, Kidney diseases with reduced formation of activated [[vitamin D]], [[Magnesium]] depletion, [[Magnesium]] over supplementation, [[Nephrotic syndrome]], [[Renal failure]], [[Rhabdomyolysis]], Severe acute [[hyperphosphatemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[DiGeorge's Syndrome]], [[Osteitis fibrosa]] following [[parathyroidectomy]], Polyglandular [[autoimmune]] syndrome
| bgcolor="Beige" | [[DiGeorge's Syndrome]], [[Osteitis fibrosa]] following [[parathyroidectomy]], Polyglandular [[autoimmune]] syndrome
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Burns]]
| bgcolor="Beige" | [[Burns]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| [[Acute renal failure]], [[Chronic renal failure]], [[Hypoproteinemia]], [[Renal failure]]
| bgcolor="Beige" | [[Acute renal failure]], [[Chronic renal failure]], [[Hypoproteinemia]], [[Renal failure]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|Postoperative, [[Transfusion]] of citrated blood
| bgcolor="Beige" |Postoperative, [[Transfusion]] of citrated blood
|-
|-
|}
|}


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{MultiCol}}
{{Columns-list|3|
* Absent active [[vitamin D]]
* Absent active [[vitamin D]]
* Absent [[parathyroid hormone]] (PTH)
* Absent [[parathyroid hormone]] (PTH)
Line 140: Line 154:
* Decreased dietary intake
* Decreased dietary intake
* Decreased [[ultraviolet]]/sun ([[vitamin D deficiency]])
* Decreased [[ultraviolet]]/sun ([[vitamin D deficiency]])
*Defective [[Vitamin D]] metabolism
* Defective [[Vitamin D]] metabolism
* Deficient [[PTH]]
* Deficient [[PTH]]
* [[DiGeorge's syndrome]]
* [[DiGeorge's syndrome]]
Line 153: Line 167:
* Following [[thyroidectomy]]
* Following [[thyroidectomy]]
* Hereditary [[hypoparathyroidism]]
* Hereditary [[hypoparathyroidism]]
* "Hungry Bone Syndrome" following [[parathyroidectomy]],
* Hungry bone syndrome following [[parathyroidectomy]]
* [[Hyperphosphatemia]]
* [[Hyperphosphatemia]]
* [[Hyperventilation]].
* [[Hyperventilation]]
* [[Hypoalbuminemia]] (pseudohypocalcemia)
* [[Hypoalbuminemia]] (pseudohypocalcemia)
{{ColBreak}}
* [[Hypomagnesemia]]
* [[Hypomagnesemia]]
* [[Hypoparathyroidism]]
* [[Hypoparathyroidism]]
Line 186: Line 199:
* [[Sepsis]]
* [[Sepsis]]
* [[Septic shock]]
* [[Septic shock]]
* Severe acute [[hyperphosphatemia]]
* [[Hyperphosphatemia]]
* [[Short bowel syndrome]]
* [[Short bowel syndrome]]
*[[Sorafenib]]
* [[Sorafenib]]
* [[Steroid]] therapy
* [[Steroid]] therapy
* [[Thyroid cancer]]
* [[Thyroid cancer]]
Line 195: Line 208:
* [[Vitamin D deficiency]]
* [[Vitamin D deficiency]]
* Vitamin-D dependent [[rickets]], type I
* Vitamin-D dependent [[rickets]], type I
{{EndMultiCol}}
* Vitamin-D dependent [[rickets]], type II
}}


==References==
==References==
{{Reflist|2}}


{{Reflist|2}}
[[Category:Needs content]]
[[Category:Cardiology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Emergency medicine]]
 
[[Category:Blood tests]]
{{WS}}
[[Category:Needs overview]]
{{WH}}
{{WH}}
{{WS}}

Latest revision as of 11:36, 13 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Hypocalcemia can be the consequence of multiple disease processes, some of which will be mentioned in the following discussion. Common causes of hypocalcemia include vitamin D insufficiency, hypoparathyroidism, renal disease, pseudohypoparathyroidism, hypomagnesemia, drugs and Fanconi syndrome etc.

Causes

Common Causes

Common causes of hypocalcemia may include:[1]

Less Common Causes

Lessn common causes of hypocalcemia may include:[2]

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning Alcohol abuse
Dermatologic No underlying causes
Drug Side Effect Anticonvulsant therapy, Cabozantinib, Capreomycin sulfate, Chelation therapy, Cinacalcet, Conjugated estrogens/bazedoxifene, Cytarabine, Dactinomycin, Diuretic therapy, Drugs, Edetate disodium, Enemas, Gallium nitrate, Gentamicin, ibandronate, laxatives, Medroxyprogesterone, Nilotinib, Oxcarbazepine, Pamidronic acid, Pentamidine Isethionate, Pramipexole, Sorafenib, Steroid, Thalidomide, Tolbutamide therapy
Ear Nose Throat No underlying causes
Endocrine Absent parathyroid hormone (PTH), Acquired hypoparathyroidism, Adrenocortical hyperplasia, Deficient PTH, Excessive secretion of calcitonin, Familial hypocalcemia, Following thyroidectomy, Hereditary hypoparathyroidism, "Hungry Bone Syndrome" following parathyroidectomy, Hypoparathyroidism, Hypoproteinemia, Medullary carcinoma of the thyroid, Osteitis fibrosa following parathyroidectomy, Osteoporosis, Pseudohypoparathyroidism, Thyroid cancer
Environmental Decreased ultraviolet/sun (vitamin D deficiency), Defective Vitamin D metabolism, Exposure to hydrofluoric acid
Gastroenterologic Acute pancreatitis, Cirrhosis, Decreased dietary intake, Eating disorders, Enemas, laxatives, Intestinal malabsorption, Malabsorption, Maldigestion, Pancreatitis, Rickets, Short bowel syndrome, Vitamin-D dependent rickets, type I
Genetic DiGeorge's Syndrome, Familial hypocalcemia
Hematologic Hypoalbuminemia (pseudohypocalcemia), Transfusion of citrated blood, Tumor lysis syndrome
Iatrogenic No underlying causes
Infectious Disease Sepsis, Septic shock
Musculoskeletal / Ortho Enhanced bone formation, Excessive secretion of calcitonin, Neonatal tetany, Osteitis fibrosa following parathyroidectomy, Osteoporosis, Rickets, Vitamin-D dependent rickets, type I
Neurologic No underlying causes
Nutritional / Metabolic Absent active vitamin D, Decreased dietary intake, Hyperphosphatemia, Intestinal malabsorption, Intravenous phosphate administration, Magnesium depletion, Rickets, Vitamin D deficiency
Obstetric/Gynecologic Breast cancer
Oncologic Breast cancer, Bronchial cancer, Medullary carcinoma of the thyroid, Osteoblastic metastases, Thyroid cancer, Tumor lysis syndrome
Opthalmologic No underlying causes
Overdose / Toxicity Magnesium over supplementation, Prolonged use of medications/laxatives containing magnesium
Psychiatric Eating disorders
Pulmonary Bronchial cancer, Hyperventilation
Renal / Electrolyte Acute renal failure, Alkalosis, Chronic renal failure, Hypomagnesemia, Hypoproteinemia, Increased diuresis with physiologic saline solution, Intravenous phosphate administration, Kidney diseases with reduced formation of activated vitamin D, Magnesium depletion, Magnesium over supplementation, Nephrotic syndrome, Renal failure, Rhabdomyolysis, Severe acute hyperphosphatemia
Rheum / Immune / Allergy DiGeorge's Syndrome, Osteitis fibrosa following parathyroidectomy, Polyglandular autoimmune syndrome
Sexual No underlying causes
Trauma Burns
Urologic Acute renal failure, Chronic renal failure, Hypoproteinemia, Renal failure
Miscellaneous Postoperative, Transfusion of citrated blood

Causes in Alphabetical Order

The unnamed parameter 2= is no longer supported. Please see the documentation for {{columns-list}}.
3

References

  1. ↑ Fong J, Khan A (February 2012). "Hypocalcemia: updates in diagnosis and management for primary care". Can Fam Physician. 58 (2): 158–62. PMC 3279267. PMID 22439169.
  2. ↑ Fong J, Khan A (February 2012). "Hypocalcemia: updates in diagnosis and management for primary care". Can Fam Physician. 58 (2): 158–62. PMC 3279267. PMID 22439169.

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