An 8-year-old girl is brought with complaints of short stature and recurrent seizures. She was started on antiepileptics about 6 months back but 2 days back she developed tetany and her serum calcium was found to be 5 mg/dL and is hence referred to endocrinology. Her calcium levels at the time of seizures were not checked in the past. She is conscious and oriented at the time of examination. Her pulse rate is 110/min and BP is 90/60 mm Hg and respiratory rate is 20/min; she is afebrile. She has moon facies and alopecia. Her BMI is normal, and secondary sexual characteristics are well-developed. There are no bony deformities in the limbs. Signs of latent tetany (Chvostek and Trousseau signs) are positive. There are bilateral cataracts but no evidence of papilledema. Examination of other systems namely cardiovascular, respiratory, and nervous is normal. Emergency investigations show low total serum calcium of 5 mg/dL (8.5–10.5 mg/dL) and her ionized calcium is 2.5 mg/dL (4.60–5.30 mg/dL). Serum magnesium level (1.5 mg/dL) is low normal and her phosphorus is 8 mg/dL (2.5–4.90 mg/dL) and her parathormone is 500 pg/mL (range 11 to 79.5 pg/mL). A noncontrast (NCCT) scan of the brain reveals bilateral basal ganglia and pineal gland calcification. The QTc interval is prolonged to 0.46 seconds. A provisional diagnosis of hypocalcemic seizures is made.
What is the formula to measure serum calcium in sick patients?
Medicine
However, no formula has proved accurate for assessment of serum calcium concentration in acutely ill patients. Critically-ill patients may have transient hypocalcemia with severe sepsis, burns, acute renal failure, extensive transfusions with citrated blood, and infusion of large amounts of albumin.
Drugs used in critical care settings such as heparin, protamine, and glucagon may also induce a transient hypocalcemia. In most of the cases, the major cause for hypocalcemia is hypoalbuminemia. Other causes of hypocalcemia in the critically ill patient include alkalosis (alkalosis increases calcium binding to proteins), hypomagnesemia, elevated circulating free fatty acids, and lipid infusions. Ionized calcium can be helpful when the diagnosis is considered in the setting of acute illness or severe hypoalbuminemia.
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