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Trey Richardson


  • Can be divided into low parathyroid hormone and high parathyroid hormone states

  • Low PTH

    • Magnesium deficiency

    • Post-operative for parathyroidectomy

    • DiGeorge syndrome

    • Medications: Bisphosphonates, denosumab, aminoglycosides, gadolinium

    • Acidemia (Serum Ca is inversely proportional to pH)

    • Infiltrative disease: sarcoid, hemochromatosis, malignancies

    • Autoimmune hypoparathyroidism

    • CRRT (if using regional citrate anticoagulation)

  • High PTH

    • Late-stage CKD

    • Hyperphosphatemia

    • Vitamin D deficiency

    • Pseudohypoparathyroidism/Parathyroid resistance

    • Consumption/deposition: Pancreatitis, rhabdomyolysis, some osteoblastic metastases

    • Sepsis or critical illness


  • Chvostek and Trousseau’s signs, laryngospasm, seizures, widened QRS and arrhythmias

  • Hemodynamic instability


  • Check PTH, albumin, iCal, VBG, Vitamin D

  • Review medications for possible offenders


  • Under most circumstances there is no need to replace calcium. Instead, focus on correcting the underlying perturbation (e.g. acidemia, hypomagnesemia, treating pancreatitis, etc. )

  • If hemodynamic instability, cardiac electrical instability, seizures then aggressive intravenous replacement is warranted.

    • Also consider preemptive repletion for patients requiring high-volume of blood transfusions (citrate in blood products can cause hypocalcemia)

    • 1 g of CaCl is equivalent to 3 grams of Ca Gluconate

  • Avoid treatment in hyperphosphatemia, advanced CKD/ESRD, and rhabdomyolysis

Last update: 2022-06-23 14:38:48