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])
Cause
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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