Hypocalcemia laboratory findings: Difference between revisions

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Revision as of 15:42, 30 March 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: hypocalcaemia; low serum calcium level

Overview

Laboratory investigations that detect alterations in PTH, vitamin D, and electrolytes in the serum or urine aids in the differential diagnosis of the underlying etiologies.

Measurement of the serum albumin concentration is essential to distinguish pseudohypocalcemia from true hypocalcemia.

Other laboratory tests include serum alkaline phosphates, liver function tests, coagulation profile, blood urea nitrogen, creatinine and urinary cAMP levels at baseline and after PTH administration.

Laboratory Differential Diagnosis of Hypocalcemia

Abbreviations: ADHP, autosomal dominant hypoparathyroidism; cAMP, cyclic adenosine monophosphate; CKD, chronic kidney disease; Cr, creatinine; Def, deficiency; HP, hyperphosphatemia; HPTH, hypoparathyroidism; PHP, pseudohypoparathyroidism; VDDR, vitamin D-dependent rickets.

↓Ca

↑PTH

↔↓PTH

↑PO4

↔↓PO4

↔Mg

↓Mg

↑Cr

↔Cr

↓25(OH)D

↔↑25(OH)D

HPTH

ADHP or Mg def

CKD

PHP or HP

Vitamin D def

↓1,25(OH)₂D

↑1,25(OH)₂D

Type I VDDR

Type II VDDR

References

@@ Line 1: / Line 1: @@
 __NOTOC__
+{| class="infobox" style="float: right;"
+| style="vertical-align: middle; padding: 5px;" align=center | [[File:Siren.gif|30px|link=Hypocalcemia resident survival guide]]
+| style="vertical-align: middle; padding: 5px;" align=center | [[Hypocalcemia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
 {{Hypocalcemia}}
 {{CMG}}
-==Laboratory Findings==
+{{SK}} hypocalcaemia; low serum calcium level
+==Overview==
+Laboratory investigations that detect alterations in PTH, vitamin D, and electrolytes in the serum or urine aids in the differential diagnosis of the underlying etiologies.
+Measurement of the serum albumin concentration is essential to distinguish pseudohypocalcemia from true hypocalcemia.
+Other laboratory tests include serum alkaline phosphates, liver function tests, coagulation profile, blood urea nitrogen, creatinine and urinary cAMP levels at baseline and after PTH administration.
+<!--
+==Laboratory Definitions for Hypocalcemia==
+* The normal range of serum total calcium concentration in adults is 8.6–10.3 mg/dL (2.15–2.57 mmol/L).<ref>{{cite book | last = Nordin | first = B. E. C. | title = Calcium, phosphate, and magnesium metabolism : clinical physiology and diagnostic procedures | publisher = Churchill Livingstone Distributed in the United States of America by Longman | location = Edinburgh New York New York | year = 1976 | isbn = 978-0443011887 }}</ref><ref>{{cite book | last = Goldman | first = Lee | title = Goldman-Cecil medicine | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2016 | isbn = 978-1455750177 }}</ref>
+* The normal range of ionized Ca<sup>++</sup> concentration in adults is 4.65–5.28 mg/dL (1.16–1.32 mmol/L).<ref>{{cite book | last = Burtis | first = Carl | title = Tietz fundamentals of clinical chemistry and molecular diagnostics | publisher = Elsevier/Saunders | location = St. Louis | year = 2015 | isbn = 978-1455741656 }}</ref><ref>{{cite book | last = Rosen | first = Clifford | title = Diseases and disorders of mineral metabolism | publisher = Wiley-Blackwell | location = Iowa, U.S.A | year = 2013 | isbn = 978-1118453889 }}</ref>
+* Hypocalcemia is defined as a total serum calcium level (adjusted for albumin) of '''< 8.4 mg/dL (2.1 mmol/L)''' or an ionized Ca<sup>++</sup> level of '''< 4.6 mg/dL (1.15 mmol/L)'''.<ref>{{cite book | last = Taal | first = Maarten | title = Brenner & Rector's the kidney | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2012 | isbn = 978-1416061939 }}</ref>
+* Adjustment of total serum calcium concentration for changes in plasma albumin level:<ref>{{Cite journal| issn = 0007-1447| volume = 1| issue = 6061| pages = 598| title = Correcting the calcium| journal = British Medical Journal| date = 1977-03-05| pmid = 843828| pmc = PMC1605322}}</ref>
+: ''Adjusted total calcium in mg/dL = Total calcium in mg/dL + 0.8 * (4 - Albumin in g/dL)''
+: ''Adjusted total calcium in mmol/L = Total calcium in mmol/L + 0.02 * (40 - Albumin in g/L)''
+-->
+==Laboratory Differential Diagnosis of Hypocalcemia==
 <span style="font-size: 85%;">
@@ Line 12: / Line 35: @@
 Cr, creatinine;
 Def, deficiency;
+HP, hyperphosphatemia;
 HPTH, hypoparathyroidism;
 PHP, pseudohypoparathyroidism;
@@ Line 17: / Line 41: @@
 </span>
-<div style="font-size: 80%;">
+<div style="font-size: 75%;">
 {{Familytree/start}}
 {{Familytree|boxstyle=border: 0;| | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | |A01={{F1|↓Ca}}}}
@@ Line 25: / Line 49: @@
 {{Familytree|boxstyle=border: 0;| | | | C01 | | | | | | | | C02 | | | | | | | C03 | | | | C04 |C01={{F1|↑PO4}}|C02={{F1|↔↓PO4}}|C03={{F1|↔Mg}}|C04={{F1|↓Mg}}}}
 {{Familytree|boxstyle=border: 0;| |,|-|-|^|-|-|.| | | |,|-|-|^|-|-|.| | | | | |!| | | | | |!| |}}
-{{Familytree|boxstyle=border: 0;| D01 | | | | D02 | | D03 | | | | D04 | | | | D05 | | | | D06 |D01={{F1|↑Cr}}|D02={{F1|↔Cr}}|D03={{F1|↓25(OH)D}}|D04={{F1|↔25(OH)D}}|D05={{F2|HPTH}}|D06={{F2|ADHP or Mg def}}}}
+{{Familytree|boxstyle=border: 0;| D01 | | | | D02 | | D03 | | | | D04 | | | | D05 | | | | D06 |D01={{F1|↑Cr}}|D02={{F1|↔Cr}}|D03={{F1|↓25(OH)D}}|D04={{F1|↔↑25(OH)D}}|D05={{F2|HPTH}}|D06={{F2|ADHP or Mg def}}}}
 {{Familytree|boxstyle=border: 0;| |!| | | | | |!| | | |!| | |,|-|-|^|-|-|.| | | | | | | | | | |}}
-{{Familytree|boxstyle=border: 0;| E01 | | | | E02 | | E03 | E04 | | | | E05 | | | | | | | | | |E01={{F2|CKD}}|E02={{F2|PHP or PO4 retention}}|E03={{F2|Vitamin D def}}|E04={{F1|↑1,25(OH)<sub>2</sub>D}}|E05={{F1|↓1,25(OH)<sub>2</sub>D}}}}
+{{Familytree|boxstyle=border: 0;| E01 | | | | E02 | | E03 | E04 | | | | E05 | | | | | | | | | |E01={{F2|CKD}}|E02={{F2|PHP or HP}}|E03={{F2|Vitamin D def}}|E04={{F1|↓1,25(OH)<sub>2</sub>D}}|E05={{F1|↑1,25(OH)<sub>2</sub>D}}}}
 {{Familytree|boxstyle=border: 0;| | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | | | |}}
-{{Familytree|boxstyle=border: 0;| | | | | | | | | | | | | | F01 | | | | F02 | | | | | | | | | |F01={{F2|Type II VDDR}}|F02={{F2|Type I VDDR}}}}
+{{Familytree|boxstyle=border: 0;| | | | | | | | | | | | | | F01 | | | | F02 | | | | | | | | | |F01={{F2|Type I VDDR}}|F02={{F2|Type II VDDR}}}}
 {{Familytree/end}}
 </div>
@@ Line 35: / Line 59: @@
 ==References==
 {{Reflist|2}}
 [[Category:Blood tests]]
 [[Category:Cardiology]]

Hypocalcemia laboratory findings: Difference between revisions

Revision as of 15:42, 30 March 2015

Overview

Laboratory Differential Diagnosis of Hypocalcemia

References

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