Review of hypocalcemia in septic patients


Address correspondence and reprint requests to:
Dr. Marie K. Holowaychuk, College of Veterinary Medicine, Veterinary Teaching Hospital, North Carolina State University, 4700 Hillsborough Street, Raleigh, NC 27606.


Objective: To review the occurrence and etiologies of hypocalcemia in septic human and veterinary patients.

Data sources: A thorough search was conducted using CAB abstracts and MEDLINE and the keywords hypocalcemia, ionized calcium, sepsis, and procalcitonin (proCT).

Human data synthesis: Ionized hypocalcemia (iHCa) is a common finding in septic human patients. The cause is unknown but is likely multifactorial. Low ionized calcium (iCa2+) concentrations coincide with increased severity of illness and increased mortality. Recent studies show that iHCa has a strong correlation with elevated calcitonin precursor concentrations.

Veterinary data synthesis: There is a paucity of publications in the veterinary literature pertaining to iHCa in septic animals. Experimental models of sepsis indicate that iHCa exists in animals. iHCa has also been investigated in horses with enterocolitis and endotoxemia. Prospective studies are needed to determine the prevalence of iHCa among septic small animals, and to determine whether iHCa correlates with increased mortality and severity of disease. Indications for the treatment of iHCa in septic small animals also need to be investigated.

Conclusions: iHCa is well documented in septic human patients, but little is known about iHCa in septic veterinary patients. Future veterinary studies should focus on documenting the presence of iHCa in septic patients and steps should be taken to determine the cause. proCT concentrations may show promise for predicting sepsis and mortality in critically ill veterinary patients.