Hypocalcemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: hypocalcaemia; low serum calcium level

Overview

Measurement of the serum albumin concentration is essential to distinguish pseudohypocalcemia from true hypocalcemia. Laboratory investigations that detect alterations in parathyroid hormone, vitamin D, and phosphate in the serum or urine aid in the differential diagnosis of the underlying etiologies. Other laboratory tests include serum alkaline phosphatase, liver function tests, coagulation profile, blood urea nitrogen, creatinine, and urinary cAMP levels at baseline or after PTH challenge.

Adjustment for Hypoalbuminemia

• Adjustment of total serum calcium concentration for changes in plasma albumin level:

Adjusted total calcium in mg/dL = Total calcium in mg/dL + 0.8 * (4 - Albumin in g/dL)

Adjusted total calcium in mmol/L = Total calcium in mmol/L + 0.02 * (40 - Albumin in g/L)

Laboratory Differential Diagnosis of Hypocalcemia

Abbreviations: ADHP, autosomal dominant hypoparathyroidism; cAMP, cyclic adenosine monophosphate; CKD, chronic kidney disease; Cr, creatinine; Def, deficiency; HP, hyperphosphatemia; HPTH, hypoparathyroidism; PHP, pseudohypoparathyroidism; VDDR, vitamin D-dependent rickets.

↓Ca

↑PTH

↔↓PTH

↑PO4

↔↓PO4

↔Mg

↓Mg

↑Cr

↔Cr

↓25(OH)D

↔↑25(OH)D

HPTH

ADHP or Mg def

CKD

PHP or HP

Vitamin D def

↓1,25(OH)2D

↑1,25(OH)2D

Type I VDDR

Type II VDDR