More causes of hypocalcaemia

Cooper and Gittoes reviewed the diagnosis and management of hypocalcaemia, but did not mention some important causes of severe hypocalcaemia in critically ill patients. Alkalosis, acute pancreatitis, and repeated transfusions can all lead to hypocalcaemia. Alkalosis increases calcium protein binding, acute pancreatitis may result in autodigestion of mesenteric fat, and blood transfusions can cause hypocalcaemia due to citrate complexing with calcium ions. Patients with autoimmune polyglandular syndrome type 1 (APECED) can also experience persistent severe hypocalcaemia despite supplementation with calcitriole and calcium. In addition to hypoparathyroidism, conditions like severe malabsorption and pancreatic insufficiency can exacerbate hypocalcaemia in these patients. Immunosuppressive treatment may be beneficial for patients with APECED who are unresponsive to standard treatments for hypocalcaemia.