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February 6, 1987

Hypocalcemia in Rhabdomyolysis-Reply

JAMA. 1987;257(5):626. doi:10.1001/jama.1987.03390050052012

In Reply.—  We thank Dr Davis for his letter related to hypocalcemia and rhabdomyolysis. Our review of hypocalcemia in critical illness did not specifically discuss rhabdomyolysis. Hypocalcemia is common during the early phase of rhabdomyolysis, especially when renal failure occurs. Early hypocalcemia is frequently followed by transient hypercalcemia during the diuretic phase of rhabdomyolysis-induced acute renal failure.1-3Early observations in soldiers with massive injury and rhabdomyolysis suggested that hypocalcemia varied with both hyperphosphatemia and the extent of tissue injury. Subsequent studies by Meroney et al4 showed that calcium salts could be deposited in traumatized muscle at rates sufficient to cause hypocalcemia. The hypocalcemia that occurs in patients with rhabdomyolysis appears to result from multiple factors. Calcium binding or accumulation in damaged muscle is known to occur. However, whether this process alone can account for the hypocalcemia remains unclear. The body is capable of mobilizing calcium from tissue stores