From the Guidelines
Hypocalcemia, hypomagnesemia, and hypokalemia workups should begin with a thorough history, physical examination, and basic laboratory tests to identify the underlying causes, with a focus on correcting magnesium levels first to address potential refractory imbalances, as recommended by the most recent guidelines 1.
Causes of Hypocalcemia
- Vitamin D deficiency
- Hypoparathyroidism
- Chronic kidney disease
- Pancreatitis
- Medication effects (bisphosphonates, anticonvulsants) Initial workup should include:
- Serum calcium (total and ionized)
- Albumin
- Phosphorus
- Magnesium
- Parathyroid hormone (PTH)
- Vitamin D levels
Causes of Hypomagnesemia
- Gastrointestinal losses (diarrhea, malabsorption)
- Renal losses (diuretics, certain antibiotics like aminoglycosides)
- Alcoholism
- Malnutrition Evaluation should include:
- Serum magnesium
- Urinary magnesium excretion
- Assessment of concurrent electrolyte abnormalities
Causes of Hypokalemia
- Inadequate intake
- Gastrointestinal losses (vomiting, diarrhea)
- Renal losses (diuretics, hyperaldosteronism)
- Transcellular shifts (insulin, beta-agonists) Workup should include:
- Serum potassium
- Urinary potassium
- Blood pressure measurement
- Assessment of acid-base status According to the most recent study 1, electrolyte abnormalities are common in patients with acute or chronic kidney disease, and close monitoring is essential to prevent complications. The use of dialysis solutions containing potassium, phosphate, and magnesium can help prevent electrolyte disorders during kidney replacement therapy 1. Additionally, the study highlights the importance of correcting magnesium levels first to address potential refractory imbalances, as magnesium deficiency can cause refractory hypocalcemia and hypokalemia 1.
From the Research
Causes of Hypocalcemia, Hypomagnesemia, and Hypokalemia
- Hypocalcemia, hypomagnesemia, and hypokalemia can be caused by various factors, including certain chemotherapies such as cisplatin, cetuximab, eribulin, and ifosfamide 2
- Alcoholism and cisplatin administration are common causes of hypomagnesemic hypokalemia and hypocalcemia 3
- Dermal exposure to hydrofluoric acid can result in severe serum calcium and magnesium depletion, leading to hypocalcemia, hypomagnesemia, and hypokalemia 4
- Disorders of calcium and magnesium balance can be caused by an interplay between the parathyroid gland, bone, intestine, and kidney, and can be influenced by hormonal regulators such as parathyroid hormone (PTH) and calcitriol 5, 6
Clinical Characteristics and Treatment
- Patients with hypomagnesemic hypokalemia and hypocalcemia may exhibit multiple interrelated acid-base and electrolyte abnormalities, including hypokalemia, hypophosphatemia, and respiratory and metabolic alkalosis 3
- Treatment of hypocalcemia, hypomagnesemia, and hypokalemia may involve administration of calcium gluconate and magnesium, both intravenously and topically, as well as oral and IV formulations of potassium and magnesium 2, 4
- Measurement of ionized calcium is the preferred way to ascertain the diagnosis of hypocalcemia and hypercalcemia 6
Workup and Diagnosis
- A thorough workup and diagnosis of hypocalcemia, hypomagnesemia, and hypokalemia are crucial to identify the underlying causes and develop an effective treatment plan 2, 3, 5, 6
- Laboratory tests, including serum electrolyte levels and acid-base balance, can help diagnose and monitor these conditions 3, 6