Skip to main content

Disorders of Calcium, Phosphorus, and Magnesium

  • Chapter
  • First Online:
Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation

Abstract

A 62-year-old man with chronic kidney disease (CKD) stage 3 undergoes an abdominal CT for workup of presumed diverticulitis. He is noted incidentally to have bilateral renal cysts and a solid mass in his right kidney. Biopsy of the mass confirms the diagnosis of renal cell carcinoma, and he is scheduled for elective nephrectomy. Prior to his scheduled nephrectomy, the patient is noted to have a serum calcium of 11.4 mg/dL with a serum albumin of 3.6 g/dL. How should this patient’s hypercalcemia be approached? What management strategies should be employed?

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 179.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 229.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. 2008;35(2):215–37. v–vi.

    Article  PubMed  Google Scholar 

  2. PalmÉR M, Jakobsson S. ÅKerstrÖM G, Ljunghall S. Prevalence of hypercalcaemia in a health survey: a 14-year follow-up study of serum calcium values. Eur J Clin Invest. 1988;18(1):39–46.

    Article  PubMed  Google Scholar 

  3. Wermers RA, Khosla S, Atkinson EJ, Hodgson SF, O’Fallon WM, Melton 3rd LJ. The rise and fall of primary hyperparathyroidism: a population-based study in Rochester, Minnesota, 1965–1992. Ann Intern Med. 1997;126(6):433–40.

    PubMed  CAS  Google Scholar 

  4. Zivin JR, Gooley T, Zager RA, Ryan MJ. Hypocalcemia: a pervasive metabolic abnormality in the critically ill. Am J Kidney Dis. 2001;37(4):689–98.

    Article  PubMed  CAS  Google Scholar 

  5. Pollak MR, Brown EM, Chou Y-HW, et al. Mutations in the human Ca2  +  -sensing receptor gene cause familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. Cell. 1993;75(7):1297–303.

    Article  PubMed  CAS  Google Scholar 

  6. Marx SJ. Familial hypocalciuric hypercalcemia. N Engl J Med. 1980;303(14):810–1.

    Article  PubMed  CAS  Google Scholar 

  7. Picolos MK, Lavis VR, Orlander PR. Milk-alkali syndrome is a major cause of hypercalcaemia among non-end-stage renal disease (non-ESRD) inpatients. Clin Endocrinol (Oxf). 2005;63(5):566–76.

    Article  Google Scholar 

  8. Conron M, Young C, Beynon HL. Calcium metabolism in sarcoidosis and its clinical implications. Rheumatology (Oxford). 2000;39(7):707–13.

    Article  CAS  Google Scholar 

  9. Labriola L, Wallemacq P, Gulbis B, Jadoul M. The impact of the assay for measuring albumin on corrected (‘adjusted’) calcium concentrations. Nephrol Dial Transplant. 2009;24(6):1834–8.

    Article  PubMed  CAS  Google Scholar 

  10. Wisneski LA. Salmon calcitonin in the acute management of hypercalcemia. Calcif Tissue Int. 1990;46(Suppl):S26–30.

    Article  PubMed  Google Scholar 

  11. Stewart AF. Hypercalcemia associated with cancer. N Engl J Med. 2005;352(4):373–9.

    Article  PubMed  CAS  Google Scholar 

  12. Sharma OP. Hypercalcemia in granulomatous disorders: a clinical review. Curr Opin Pulm Med. 2000;6(5):442–7.

    Article  PubMed  CAS  Google Scholar 

  13. Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999;83(2):302–20.

    Article  PubMed  CAS  Google Scholar 

  14. Elin RJ. Magnesium: the fifth but forgotten electrolyte. Am J Clin Pathol. 1994;102(5):616–22.

    PubMed  CAS  Google Scholar 

  15. Elin RJ. Assessment of magnesium status. Clin Chem. 1987;33(11):1965–70.

    PubMed  CAS  Google Scholar 

  16. Whang R, Ryder KW. Frequency of hypomagnesemia and hypermagnesemia. Requested vs routine. JAMA. 1990;263(22):3063–4.

    Article  PubMed  CAS  Google Scholar 

  17. Whang R, Oei TO, Aikawa JK, et al. Predictors of clinical hypomagnesemia. Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia. Arch Intern Med. 1984;144(9):1794–6.

    Article  PubMed  CAS  Google Scholar 

  18. Regolisti G, Cabassi A, Parenti E, Maggiore U, Fiaccadori E. Severe hypomagnesemia during long-term treatment with a proton pump inhibitor. Am J Kidney Dis. 2010;56(1):168–74.

    Article  PubMed  Google Scholar 

  19. Izzedine H, Bahleda R, Khayat D, et al. Electrolyte disorders related to EGFR-targeting drugs. Crit Rev Oncol Hematol. 2010;73(3):213–9.

    Article  PubMed  Google Scholar 

  20. Khositseth S, Sudjaritjan N, Tananchai P, Ong-ajyuth S, Sitprija V, Thongboonkerd V. Renal magnesium wasting and tubular dysfunction in leptospirosis. Nephrol Dial Transplant. 2008;23(3):952–8.

    Article  PubMed  CAS  Google Scholar 

  21. Agus ZS. Hypomagnesemia. J Am Soc Nephrol. 1999;10(7):1616–22.

    PubMed  CAS  Google Scholar 

  22. Mordes JP, Wacker WE. Excess magnesium. Pharmacol Rev. 1977;29(4):273–300.

    PubMed  CAS  Google Scholar 

  23. Kelber J, Slatopolsky E, Delmez JA. Acute effects of different concentrations of dialysate magnesium during high-efficiency dialysis. Am J Kidney Dis. 1994;24(3):453–60.

    PubMed  CAS  Google Scholar 

  24. Bundy JT, Connito D, Mahoney MD, Pontier PJ. Treatment of idiopathic renal magnesium wasting with amiloride. Am J Nephrol. 1995;15(1):75–7.

    Article  PubMed  CAS  Google Scholar 

  25. Gaasbeek A, Meinders AE. Hypophosphatemia: an update on its etiology and treatment. Am J Med. 2005;118(10):1094–101.

    Article  PubMed  CAS  Google Scholar 

  26. Camp MA, Allon M. Severe hypophosphatemia in hospitalized patients. Miner Electrolyte Metab. 1990;16(6):365–8.

    PubMed  CAS  Google Scholar 

  27. Levin A, Bakris GL, Molitch M, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int. 2007;71(1):31–8.

    Article  PubMed  CAS  Google Scholar 

  28. Hall AM, Hendry BM, Nitsch D, Connolly JO. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. Am J Kidney Dis. 2011;57(5):773–80.

    Article  PubMed  CAS  Google Scholar 

  29. Francois H, Coppo P, Hayman JP, Fouqueray B, Mougenot B, Ronco P. Partial fanconi syndrome induced by imatinib therapy: a novel cause of urinary phosphate loss. Am J Kidney Dis. 2008;51(2):298–301.

    Article  PubMed  CAS  Google Scholar 

  30. Berman E, Nicolaides M, Maki RG, et al. Altered bone and mineral metabolism in patients receiving imatinib mesylate. N Engl J Med. 2006;354(19):2006–13.

    Article  PubMed  CAS  Google Scholar 

  31. Osorio S, Noblejas AG, Duran A, Steegmann JL. Imatinib mesylate induces hypophosphatemia in patients with chronic myeloid leukemia in late chronic phase, and this effect is associated with response. Am J Hematol. 2007;82(5):394–5.

    Article  PubMed  CAS  Google Scholar 

  32. Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition. 2001;17(7–8):632–7.

    Article  PubMed  CAS  Google Scholar 

  33. Kebler R, McDonald FD, Cadnapaphornchai P. Dynamic changes in serum phosphorus levels in diabetic ketoacidosis. Am J Med. 1985;79(5):571–6.

    Article  PubMed  CAS  Google Scholar 

  34. Brunelli SM, Goldfarb S. Hypophosphatemia: clinical consequences and management. J Am Soc Nephrol. 2007;18(7):1999–2003.

    Article  PubMed  CAS  Google Scholar 

  35. Shiber JR, Mattu A. Serum phosphate abnormalities in the emergency department. J Emerg Med. 2002;23(4):395–400.

    Article  PubMed  Google Scholar 

  36. Miller DW, Slovis CM. Hypophosphatemia in the emergency department therapeutics. Am J Emerg Med. 2000;18(4):457–61.

    Article  PubMed  CAS  Google Scholar 

  37. Rosen GH, Boullata JI, O’Rangers EA, Enow NB, Shin B. Intravenous phosphate repletion regimen for critically ill patients with moderate hypophosphatemia. Crit Care Med. 1995;23(7):1204–10.

    Article  PubMed  CAS  Google Scholar 

  38. Clark CL, Sacks GS, Dickerson RN, Kudsk KA, Brown RO. Treatment of hypophosphatemia in patients receiving specialized nutrition support using a graduated dosing scheme: results from a prospective clinical trial. Crit Care Med. 1995;23(9):1504–11.

    Article  PubMed  CAS  Google Scholar 

  39. Taylor BE, Huey WY, Buchman TG, Boyle WA, Coopersmith CM. Treatment of hypophosphatemia using a protocol based on patient weight and serum phosphorus level in a surgical intensive care unit. J Am Coll Surg. 2004;198(2):198–204.

    Article  PubMed  Google Scholar 

  40. Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med. 2010;362(14):1312–24.

    Article  PubMed  CAS  Google Scholar 

  41. Markowitz GS, Stokes MB, Radhakrishnan J, D’Agati VD. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J Am Soc Nephrol. 2005;16(11):3389–96.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. Kevin Tucker M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Tucker, J.K., Thornley-Brown, D. (2013). Disorders of Calcium, Phosphorus, and Magnesium. In: Lerma, E., Rosner, M. (eds) Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4454-1_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-4454-1_11

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-4453-4

  • Online ISBN: 978-1-4614-4454-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics