**4. Calcium and phosphate balance**


• Calcium balance is regulated by the parathyroid hormone and calcitriol which affects intestinal absorption, bone formation/ resorption and urinary excretion. Phosphorus balance is primarily regulated by the parathyroid hormone [38].

diuretics, chemotherapy (cisplatin, 5-fluorouracil) and drugs that inhibit

bone reabsorption (bisphosphonates, calcitonin and denosumab)

3.Pancreatitis (especially in hypertriglyceridemia induced pancreatitis)

6.Chronic conditions such as hypoparathyroidism, Vit D deficiency or

• Most critically ill patients have hypocalcemia and treatment is usually not indicated. Treatment is indicated when patient is symptomatic, presence of prolonged QT interval or severe hypocalcemia (ionized calcium<0.8) [37, 39].

• First, IV loading dose can be given (1 g calcium chloride or 2-3 g calcium gluconate) followed by maintenance doses if there is an ongoing process with smaller doses (for example calcium gluconate 1 g q1h as needed). IV calcium increases ionized calcium in patients with hypocalcemia, but randomized trials have not evaluated effect on clinical outcomes [40]. IV calcium can eventually

• For mild- moderate hypocalcemia, therapy can be started with oral calcium.

• Treatment of hypocalcemia is contraindicated in hyperphosphatemia (could cause precipitation of calcium phosphate, calciphylaxis), ethylene glycol poisoning (calcium promotes calcium oxalate precipitation in the brain) and

• Hypercalcemia is a serum calcium>10.5 mg/dl or ionized calcium>5.6 mg/dl. Calcium is partially bound to albumin therefore should be adjusted based on albumin. Only ionized calcium is biologically active so, if available, ionized calcium should be used to manage hypercalcemia among critically

• IV calcium can be used in symptomatic/severe cases or in the presence of EKG changes. IV formulations are calcium chloride (central access) and calcium gluconate (peripheral access). Both are equally fast however calcium chloride

4. Increased Citrate:- Seen in massive transfusion, plasmapheresis,

2. Severe Inflammation seen in sepsis or major buns

leukapheresis and renal replacement therapy.

7.Chronic Kidney disease (most common cause)

5.Alkalosis

*Electrolytes in the ICU*

osteoblastic metastasis.

*DOI: http://dx.doi.org/10.5772/intechopen.96957*

can cause tissue necrosis if it extravasates.

be transitioned to oral formulations.

**4.2 Hypercalcemia**

*4.2.1 Introduction*

ill [41].

**151**

Usual dose is calcium carbonate 1 g every 12 hours.

digoxin poisoning (theoretical contraindication).

• Hypercalcemia can be classified based on severity:

