Sepsis and calcium

 Q: Sepsis tends to do (select one)

A) Hypocalcemia

B) Hypercalcemia

Answer: A

Hypocalcemia is more common in ICU. Patients with sepsis, burn, any other severe illness, or after surgery may develop clinically significant hypocalcemia. There are various complex mechanisms involved simultaneously. 

There is a decreased secretion of Parathyroid hormone (PTH) and calcitriol. These patients also manifest end-organ resistance to PTH due to hypomagnesemia and inflammatory cytokines on the parathyroid glands, kidneys, and bone. It has also been suggested that these patients may have high serum calcitonin concentrations which lead to inhibit bone resorption.

#electrolytes

References:

1. Zivin JR, Gooley T, Zager RA, Ryan MJ. Hypocalcemia: a pervasive metabolic abnormality in the critically ill. Am J Kidney Dis 2001; 37:689. 

2. Desai TK, Carlson RW, Geheb MA. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med 1988; 84:209. 

3. Zaloga GP, Chernow B. The multifactorial basis for hypocalcemia during sepsis. Studies of the parathyroid hormone-vitamin D axis. Ann Intern Med 1987; 107:36. 

4. Sperber SJ, Blevins DD, Francis JB. Hypercalcitoninemia, hypocalcemia, and toxic shock syndrome. Rev Infect Dis 1990; 12:736.