• There is a reciprocal relationship between serum Ca & Phos concentration
  • We’re concerned about free calcium not total body calcium when considering supplementation
  • Corrected calcium = accounts for a decrease in percent of protein binding due to a decrease in serum albumin concentration
  • Serum [Ca] < 6.5 mg/dL   or ionized [Ca] < 1.12 mmol/L
  • Signs/symptoms:  tetany, hypoactive reflexes, depression/hallucinations, hypotension/acute myocardial failure, lethargy/stupor, Trousseau’s and Chvostek’s signs
  • Causes:  hypoparathyroidism, hypomagnesemia, hyperphosphatemia, chronic renal failure, vitamin D deficiency, acute pancreatitis, alkalosis, hypoalbuminemia
  • Medications that can lead to hypocalcemia:  loop diuretics, corticosteroids, phenytoin/phenobarb, cisplatin, foscarnet, interferon-alpha, pentamidine, phosphate replacement products
  • Trxt: Ca carb (oral), Ca citrate (oral), Ca gluconate (IV–less irritating), CaCl (IV–irritating, use central line)
    • Must restore Mg to adequately correct Ca deficiency

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