Critical Illness and Calcium Metabolism

  • Jack F. Tohme
  • John P. Bilezikian
Part of the Contemporary Endocrinology book series (COE, volume 4)


Calcium is a vital ion serving a variety of extracellular and intracellular functions. Extracellular calcium is predominantly in the skeleton (over 99% of total body calcium) where it supports bodily movement and protects vital organs. Extracellular calcium also plays important roles in blood clotting, in maintenance of cell membrane integrity, and in mechanisms of intercellular adhesion. Basic intracellular functions include muscle contraction, intracellular signaling, cell movement, enzyme activation, and neurohumoral secretion (1). Alterations in the concentration of serum ionized calcium can therefore be expected to have clinically significant consequences. An acute reduction in serum calcium concentration can lead to hyperexcitability of nerve and muscle tissues, presenting a constellation of symptoms and signs that are encompassed by the term, “tetany.” Hypocalcemia can be a medical emergency when symptoms are manifest as laryngeal spasm or seizures. An acute increase in the serum calcium concentration can also be life-threatening when neurological functions are depressed, especially if the central nervous system is involved. A wide variety of acute illnesses can cause or be accompanied by hypocalcemia and hypercalcemia (1–4). This chapter reviews the clinical yndromes associated with acute alterations in calcium metabolism and summarizes current concepts in management.


Acute Pancreatitis Parathyroid Gland Primary Hyperparathyroidism Calcium Metabolism Serum Calcium Concentration 
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© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Jack F. Tohme
  • John P. Bilezikian

There are no affiliations available

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