Diagnosis and Treatment of the Patient with Abnormal Calcium

  • Elizabeth H. HoltEmail author


The author describes normal physiology of calcium and phosphorus metabolism and the chemistries associated with their pathophysiology in adults. Extensive discussions are presented about abnormalities of body chemistry in the hypercalcemic and hypocalcemic conditions. The clinical signs and symptoms of patients with these abnormalities are highlighted and provide a framework for diagnosing them. Treatment options for these conditions are given with extensive orientation towards medical therapies.


Calcium homeostasis Serum calcium levels Cholecalciferol Hydroxylation Vitamin D3 Calcitriol Ionized calcium Calcium-sensing receptor CaSR Bone resorption Calcium resorption Distal nephron Laboratory measurement Hypercalcemia Signs Symptoms Etiology History Phsyical examination Dehydration Polyuria Polydypsia Disorientation Primary hyperparathyroidism Nephrolithiasis Medications Sarcoidosis Multiple endocrine neoplasia Malignanacy Orthostasis Band keratopathy Granulomatous Kyphosis Costovertebral Diagnostic evaluation Plasma protein Multiple myeloma Chronic hepatitis HIV infection Renal function Intact PTH Immunochemiluminometric assay ICMA 25(OH) vitamin D 1,25(OH)2 vitamin D Nephrocalcinosis Alkaline phosphatase Hypercalciuria Electrocardiography QTc interval Atriventricular block DEXA Dual energy X-ray absorptiometry Radiographs Normocalcemia Renal failure Osteitis fibrosa cystica MEN I MEN II Lithium Familial hypocalciuric hypercalcemia Tertiary hyperparathyroidism Intestinal malabsorption Hyperphosphatemia Bicarbonate reabsorption Hypophosphatemia Markers of bone turnover Pheochromocytoma Thyroid cancer PTH-independent hypercalcemia Humoral hypercalcemia of malignancy Local osteolytic hypercalcemia PTHrP B cell lymphomas Tuberculosis Saline hydration Bisphosphonate Pamidronate Zoledronic acid Parathyroidectomy Calcitonin Tachyphylaxix Hemodialysis Immobilization Calcimimetic Cinacalcet Neuromuscular Tremor Muscle spasm Paresthesias Hypoparathyroidism Autoimmune disease Tumor lysis syndrome Transfusion therapy Rhabdomyolysis Shvostek sign Trousseau sign Tetany Seizure Hemodilution Albumin serum Protein malnutrition Nephrotic ­symdrome Hungry bone syndrome Mucocutaneous candidiasis Hypmagnesemia Pseudohypoparathyroidism Calcium infusion Calcium gluconate 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Section of Endocrinology and Metabolism, Department of Internal MedicineYale University of MedicineNew HavenUSA

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