Causes of Hypocalcemia - Differential Diagnosis
Decreased calcium absorption
• Vitamin D deficiency
- Decreased oral intake - Malnutrition
- Decreased intestinal absorption - Intestinal bypass, gastrectomy
- Decreased production of 25(OH)D3 - Liver failure
- Decreased synthesis of 1,25(OH2)D3 - Renal failure, hyperphosphatemia
• Malabsorption Syndromes
Increased calcium excretion/reduced bone resorption
• Alcoholism - Hypomagnesemia causing inhibition of PTH secretion, PTH resistance to bone resorption
• Hypoparathyroidism - Genetic, autoimmune, surgical, tumoral
• Pseudohypoparathyroidism - Resistance to PTH action
• Hypomagnesemia - Inhibition of PTH secretion, PTH resistance to bone resorption
• Drugs
• Miscellaneous
• Sepsis
• Acute pancreatitis - Fatty acids combine with [Ca2+] to form insoluble Ca2+ soaps and lead to a reduction of serum [Ca2+]
• Massive transfusions
• Rhabdomyolysis
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