Hypocalcemia in Emergency Medicine Workup

  • Author: Christopher B Beach, MD, FACEP, FAAEM; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Feb 11, 2011
 

Laboratory Studies

  • Symptomatic patients with classic clinical findings of acute hypocalcemia require immediate resuscitation and evaluation. However, most cases of hypocalcemia are discovered by clinical suspicion and appropriate laboratory testing.
  • Calcium levels
    • A serum calcium level less than 8.5 mg/dL or an ionized calcium level less than 1.0 mmol/L is considered hypocalcemia.
    • Analysis for ionized level must be performed rapidly with whole blood to avoid changes in pH and anion chelation. Blood should be drawn in an unheparinized syringe for best results.
    • Falsely elevated calcium levels may be seen with elevated acetaminophen levels, alcohol, hydralazine, and hemolysis.
    • Falsely depressed levels can be seen with heparin, oxalate, citrate, or hyperbilirubinemia.
  • Magnesium, phosphate, and other electrolyte levels should be obtained.
  • Elevated BUN and creatinine levels may indicate renal dysfunction.
  • Albumin, liver function studies, and coagulation parameters should be obtained to assess liver dysfunction and hypoalbuminemia.
  • The PTH level (an antibody-mediated radioimmunoassay) should be checked as early as possible.
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Imaging Studies

  • Depending on the patient's clinical status and the suspected etiology of hypocalcemia, imaging studies may or may not be indicated in the ED.
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Other Tests

  • ECG and electrocardiographic monitoring should be obtained to rule out dysrhythmias and a prolonged QT interval.
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Contributor Information and Disclosures
Author

Christopher B Beach, MD, FACEP, FAAEM  Associate Professor and Vice Chairman of Emergency Medicine, Department of Emergency Medicine, Northwestern University, The Feinberg School of Medicine

Christopher B Beach, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin R Hemphill, MD, MPH  Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

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