Calcium Imbalances: Causes and Manifestations

    • Nursing implementation
      • Treat cause
      • Oral or IV calcium supplements
      • Rebreathe into paper bag
      • Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis

Calcium Imbalances: Causes and Manifestations

Hypercalcemia (Ca2+ >10.2 mg/dL [2.55 mmol/L])

Hypocalcemia (Ca2+ <8.6 mg/dL [2.15 mmol/L])


  • Increased Total Calcium
  • Decreased Total Calcium
  • Hyperparathyroidism
  • Primary hypoparathyroidism
  • Hematologic malignancy
  • Renal insufficiency
  • Malignancies with bone metastasis
  • Acute pancreatitis
  • Prolonged immobilization
  • Elevated phosphorus
  • Vitamin A or D overdose
  • Vitamin D deficiency, malnutrition
  • Paget’s disease
  • Magnesium deficiency
  • Adrenal insufficiency
  • Bisphosphonates
  • Thyrotoxicosis
  • Tumor lysis syndrome
  • Thiazide diuretics
  • Loop diuretics
  • Milk-alkali syndrome
  • Chronic alcoholism
  • Calcium-containing antacids
  • Diarrhea
  • Mycobacterium infection
  • Decreased Serum albumin

Increased Ionized Calcium

Decreased Ionized Calcium

  • Acidosis
  • Alkalosis
  • Excess administration of citrated blood

ECG changes

  • Shortened ST segment
  • Elongation of ST segment
  • Shortened QT interval
  • Prolonged QT interval
  • Ventricular dysrhythmias
  • Ventricular tachycardia
  • Increased digitalis effect


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