Disordered calcium homeostasis of sepsis: association with calcitonin precursors

Authors: Müller B.^{1, *}; Becker K.L.³; Kränzlin M.¹; Schächinger H.¹; Huber P.R.¹; Nylèn E.S.³; Snider R.H.³; White J.C.³; Schmidt-Gayk H.²; Zimmerli W.¹; Ritz R.¹

Source: European Journal of Clinical Investigation, Volume 30, Number 9, September 2000 , pp. 823-831(09)

Publisher: Wiley-Blackwell

Abstract:

Hypocalcemia and increased serum levels of calcitonin precursors are common in critically ill patients, especially in those with sepsis. We investigated calcium homeostasis in such patients.

Serum concentrations of total and ionized calcium and known factors influencing or reflecting calcium homeostasis were measured in 101 consecutive patients of a medical intensive care unit. Calcitonin precursor levels were determined using a highly sensitive radioimmunoassay.

Critical illness per se was associated with decreased serum total and ionized calcium levels, which correlated with the severity of the underlying disease as measured by the APACHE II score. In addition, total and ionized hypocalcemia was more pronounced with increasing severity of infection (P < 0.02), and occurred in parallel with a marked increase of calcitonin precursors (P < 0.001). Mature calcitonin levels, however, remained normal. Changes of serum ionized calcium concentrations from admission to discharge correlated significantly with changes in the serum calcitonin precursor concentration (r² = - 0.14, P < 0.001). Circulating vitamin D levels, parathyroid hormone levels and other markers reflecting calcium homeostasis did not correlate with the severity of infection.

In critically ill patients with sepsis, markedly elevated circulating calcitonin precursors might play a role in the development of the pronounced hypocalcemia. The specific calcitonin precursor(s) responsible for this effect and the pathophysiological mechanism remain to be elucidated.

Keywords: Calcitonin; hypocalcemia; infection; parathyroid hormone; procalcitonin; vitamin D

Language: English

Document Type: Research article

Affiliations: 1: University Hospitals, CH-4031 Basel, Switzerland 2: Laborärztliche Gemeinschaftspraxis, Heidelberg, Germany 3: Veterans Affairs Medical Center and George Washington University, Washington DC, USA *

Publication date: 2000-09-01

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• In this Subject: Public Health
• By this author: Müller B. ;  Becker K.L. ;  Kränzlin M. ;  Schächinger H. ;  Huber P.R. ;  Nylèn E.S. ;  Snider R.H. ;  White J.C. ;  Schmidt-Gayk H. ;  Zimmerli W. ;  Ritz R.

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