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Calcium homeostasis during therapeutic plasma exchange

Because the removal of substantial quantities of plasma calcium during plasma exchange is rarely attended by clinically significant hypocalcemia, we evaluated calcium homeostasis during this procedure. Twenty‐one procedures were performed on 10 patients with various neurological disorders. The reduction by plasma exchange in the serum concentrations of total calcium, ionized calcium, magnesium, and phosphate was significantly less than predicted (p < 0.001) based on plasma volume of the patient and size of the exchange. However, N‐terminal parathomone (PTH) levels increased to 242 ± 120 percent midway into the procedure and were 207 ± 84 percent after plasma exchange; urinary cyclic adenosine monophosphate (cAMP) levels rose by 165 ± 35 percent.