Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jan 1;13(1):e12420.
doi: 10.7759/cureus.12420.

Disorders of Calcium Metabolism: Hypocalcemia and Hypercalcemia

Mohammad Tinawi  1   2
Affiliations
Review

Disorders of Calcium Metabolism: Hypocalcemia and Hypercalcemia

Mohammad Tinawi. Cureus. .

Abstract

Calcium (Ca+2) is a divalent cation that plays a critical role in numerous body functions such as skeletal mineralization, signal transduction, nerve conduction, muscle contraction, and blood coagulation. Ca+2 metabolism is linked to magnesium (Mg+2) and phosphate metabolism. Ca+2 homeostasis is dependent on intestinal absorption, bone turnover, and renal reabsorption. The hormonal regulators of these processes are the parathyroid hormone (PTH), calcitriol {1,25-dihydroxyvitamin D [1,25(OH)2D]}, and serum ionized Ca+2. Cloning of the Ca+2-sensing receptor (CaSR) has greatly advanced the understanding of Ca+2 metabolism. Disorders of Ca+2 metabolism are easily recognized because Ca+2 is included in routine chemistry panels. Measurement of ionized Ca+2 is the preferred way to ascertain the diagnosis of hypocalcemia and hypercalcemia.

Keywords: calcium metabolism; calcium sensing receptor; electrolyte disorders; hypercalcemia; hypocalcemia.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The three different forms of serum calcium
Complexed calcium is bound to anions such as citrate, oxalate, carbonate, and phosphate
Figure 2
Figure 2. Calcium homeostasis
Approximately 500 mg of calcium is exchanged daily between the ECF and the bone ICF: intracellular fluid; ECF: extracellular fluid Image of the kidney is courtesy of Servier Medical Art licensed under a Creative Commons Attribution 3.0 Unported License. https://smart.servier.com
Figure 3
Figure 3. Calcium and magnesium reabsorption in the TAL via the paracellular route
The process is passive and depends on sodium and potassium uptake via the Na-K-2Cl pump Na-K-2Cl: sodium-potassium-2 chloride pump; ROMK: the renal outer medullary potassium channel; TIL: thick ascending limb; ATP: adenosine triphosphate Courtesy of Tinawi M, Disorders of Magnesium Metabolism: Hypomagnesemia and Hypermagnesemia. Arch Clin Biomed Res, 4(3): 205-220, 2020; an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license 4.0
See this image and copyright information in PMC

References

    1. Calcium metabolism in health and disease. Peacock M. Clin J Am Soc Nephrol. 2010;5:0–30. - PubMed
    1. Renal control of calcium, phosphate, and magnesium homeostasis. Blaine J, Chonchol M, Levi M. Clin J Am Soc Nephrol. 2015;10:1257–1272. - PMC - PubMed
    1. Pitfalls of measuring total blood calcium in patients with CKD. Gauci C, Moranne O, Fouqueray B, et al. J Am Soc Nephrol. 2008;19:1592–1598. - PMC - PubMed
    1. Chonchol M, Smogorzewski M, Stubbs J, Yu AS. Brenner & Rector's The Kidney. Vol. 11. Philadelphia, PA: Elsevier Inc; 2019. Disorders of calcium, magnesium, and phosphate balance; p. 613.
    1. Minireview on regulation of intestinal calcium absorption. Emphasis on molecular mechanisms of transcellular pathway. Pérez AV, Picotto G, Carpentieri AR, Rivoira MA, Peralta López ME, Tolosa de Talamoni NG. Digestion. 2008;77:22–34. - PubMed

LinkOut - more resources