Hypocalcemia - Differential Diagnosis Algorithm - Low and High Phosphate
LOW PHOSPHATE
- Low/NormaI PTH
• Severe Malnutrition with Hypomagnesemia
- High PTH
• Vitamin D Deficiency (e.g. Diet, Malabsorption, Phenytoin, Nephrotic Syndrome, Hepatobiliary Disease)
• Hereditary Vitamin D Resistance
• 1-alpha-hydroxylase Deficiency
HIGH PHOSPHATE
- Normal Creatinine - Low/NormaI PTH
• Hypoparathyroidism (e.g. Acquired, Autoimmune, Idiopathic, Congenital, Infiltrative)
• Activating Mutation in Calcium Sensing Receptor (CaSR)
• Hypomagnesemia
- Normal Creatinine - High PTH
• PTH Resistance (Pseudo-hypoparathyroidism)
• Calcium Complexing
• (Citrate Infusion, Pancreatitis)
- High Creatinine - Low PTH
• Hypoparathyroidism with Chronic Kidney Disease
- High Creatinine - High PTH
• Secondary Hyperparathyroidism
• Rhabdomyolysis
• Phosphate Poisoning
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