Disorders of Calcium Metabolism

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry


Malignancy and hyperparathyroidism are the most common causes of hypercalcaemia, and malignancy accounts for about 65% in the hospital. Patients with acute hypercalcaemia usually present with gastrointestinal symptoms such as nausea, vomiting, anorexia and dehydration. Hypercalcaemia may produce ECG changes. Hypocalcaemia has a prevalence of 85% in ICU and 18% of all hospital patients. Patients with hypocalcaemia are symptomatic (tetany, seizures) or at high risk of developing complications. The chapter discusses the mechanisms underlying the disorders of calcium metabolism, their clinical manifestations and management.


Hypercalcaemia Hypocalcaemia Hyperparathyroidism Malignancy 


  1. 1.
    Frolich A. Prevalence of hypercalcaemia in normal and hospital populations. Dan Med Bull. 1998;45(4):436–9.PubMedGoogle Scholar
  2. 2.
    Sexton TB,Cohen C. Hypercalcaemia and calcium metabolism in the elderly. Contemporary Geriatric Medicine. 198;3:437–453.Google Scholar
  3. 3.
    Dent DM, Miller JL, Klaff L, Barron J. The incidence and causes of hypoercalcaemia. Postgrad Med J.1987;63(73):745–750.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lafferty FW. Differential diagnosis of hypercalcaemia. J Bone Miner Res. 1991;Suppl 2:S51–9.Google Scholar
  5. 5.
    Raymakers JA. Hypercalcaemia in the elderly Tijdschi Gerontol Geriatr. 1990;21(1):11–6.Google Scholar
  6. 6.
    Koh LK. The diagnosis and management of hypercalcaemia. Ann Acad Med Singapore. 2003;32(1): 129–39.PubMedGoogle Scholar
  7. 7.
    Chia BL,Thai AC. Electrocardiographic abnormalities in combined hypercalcaemia and hypokalaemia-Case Report. Ann Acad Med Singapore. 1998;227:567–9.Google Scholar
  8. 8.
    Turhan S, Kilickap M, Kiline S. ST segment elevations mimicking acute myocardial infarction in hyperkalaemia. Health. 2005;91(8):999.Google Scholar
  9. 9.
    Wesson Lc, Suresh V, Parry RG. Hypercalcaemia simulating acute myocardial infarction. Clin Med. 2009;9(2):186–7.CrossRefGoogle Scholar
  10. 10.
    Nussbaum SR. Pathophysiology and management of severe hypercalcaemia. Endocrinol Metab Clin North Am. 1993; 22(2):343–62.PubMedGoogle Scholar
  11. 11.
    Pecherstirfer M, Brenner K, Zojer N. Current management strategies for hypercalcaemia. Treat Endocrinol. 2003;2(4):273–9.CrossRefGoogle Scholar
  12. 12.
    Ralston SH. Medical management of hypocalcaemia. Br J Clin Pharmacol. 1992;34(1):11–20.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hasbacka J, Pettila V. Prevalence and prediction value of ionised hypocalcaemia among critically ill patients. Acta Anaesthesia Scand. 2003;47:1264–9.CrossRefGoogle Scholar
  14. 14.
    Shah AB, Foo YN. A retrospective study of serum calcium levels in hospital population in Malaysia. Med J Malaysia.1995;50:246–9.Google Scholar
  15. 15.
    Cooper MS, Gittoes NJL. Diagnosis and management of hypocalcaemia. BMJ. 2008;336 (7556):1298–1302.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Beach CB. Hypocalcaemia emedicine accessed 13.12.08.
  17. 17.
    Urbano FL. Signs of hypocalcaemia. Chvostek’s and Trousseau’s Hosp Physician. 2000;36:43–5.Google Scholar
  18. 18.
    RuDusky BM. Electrocardiographic abnormalities associated with hypocalcaemia. Chest. 2001;119(2):668–669.CrossRefPubMedGoogle Scholar
  19. 19.
    Bronsky D,Dubin D, Waldstein S, Kushner DS. Calcium and the electrocardiogram. Am J Cardiol. 1961;7:833.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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