Episode 12 – The Dark Side of Electrolytes (Part 4: Calcium)


In this episode, we continue our electrolyte series by focusing on one of the most abundant minerals in our body: calcium.  Calcium is an ion that plays a number of roles in maintaining homeostasis, and it is readily available for administration for most of us in both the pre-hospital and hospital setting.  Tune in as we discuss total calcium and its affects on our critically ill patients; primarily focusing on the measurement of ionized calcium (iCa) levels, and the appropriate treatments for both hypo and hyper states.


 – Use caution when interpreting Ca based on unit of measure.  

– Utilize iCa (biologically active).

 – Total Ca is affected by Albumin and pH.

 – Know what Ca you carry (gluconate vs. chloride).  Know how to administer it.

– Keep Ca in mind for trauma patients (e.g. clotting cascade, banked blood and citrate).

– Ca is a strong inotrope.  Normal or high values ideal for cardiogenic-related hypotension.

Ca: 8-10 mg/dL

iCa: 4.5-5.1 mEq/L, 1.2-3.2 mmol/L (iSTAT)

Agraharkar, M., Dellinger, O. D., Gangakhedkar, A. K., & Batuman, V. (2016, August 2). Hypercalcemia. Retrieved from https://emedicine.medscape.com/article/240681-overview

Higgins, C. (2007, July). Ionized calcium. Retrieved from http://acutecaretesting.org/en/articles/ionized-calcium

Hypomagnesemia with secondary hypocalcemia. (2017, November 28). Retrieved from http://ghr.nlm.nih.gov/condition/hypomagnesemia-with-secondary-hypocalcemia

Lewis, J. L., III. (2017). Hypercalcemia. Retrieved from http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypercalcemia

Li, M. X., & Hwang, P. M. (2015). Structure and function of cardiac troponin C (TNNC1): Implications for heart failure, cardiomyopathies, and troponin modulated drugs. Gene, 571(2), 153-166.

Suneja, M., Muster, H. A., & Batuman, V. (2017, October 24). Hypocalcemia. Retrieved from https://emedicine.medscape.com/article/241893-overview#a5

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