Pediatric emergency medicine trisk 2871 2871
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approximately 0.8 mg/dL. Hypoalbuminemia does not affect the ionized
calcium concentration, which is under hormonal regulation. If available,
previous calcium levels should be reviewed to determine if the patient is
experiencing an acute or chronic process. Though results will not be
available during an urgent or emergent assessment period, a serum PTH
level must be performed in all patients with confirmed hypocalcemia.
Measurement of serum phosphate, magnesium, and creatinine should also
be performed. Hyperphosphatemia increases the risk for calcium phosphate
precipitation in tissues and may lead to hypocalcemia. Magnesium is
required for PTH release, and hypomagnesemia results in decreased
responsiveness to the effect of PTH in target organs. Hypocalcemia is
common in renal failure and is due to phosphate retention and insufficient
production of 1,25-dihydroxyvitamin D. As timely serum PTH levels may
not be available for review, urine calcium, phosphate, and creatinine should
be submitted to assess renal tubular handling, which may suggest the PTH
effect. Vitamin D metabolites should be performed in selected patients if
clinically indicated.
