Hypocalcemia
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| Hypocalcemia Classification and external resources | |
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| Calcium | |
| ICD-10 | E83.5 |
| ICD-9 | 275.41 |
| DiseasesDB | 6412 |
| eMedicine | emerg/271 |
| MeSH | D006996 |
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US National Guidelines Clearinghouse on Hypocalcemia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
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Overview
Hypocalcemia is the presence of low serum calcium levels in the blood, usually taken as less than 3.5 mmol/L or 8.8 mg/dl or an ionized calcium level of less than 1.1 mmol/L (4.5 mg/dL). It is a type of electrolyte disturbance. In the blood, about half of all calcium is bound to proteins such as serum albumin, but it is the unbound, or ionized, calcium that the body regulates. If a person has abnormal levels of blood proteins then the plasma calcium may be inaccurate. The ionized calcium level is considered more clinically accurate in this case.
Calcium is the most abundant mineral in the body. 99% of the body's calcium is stored in bone. Calcium is found in plasma and is either protein-bound or ionized and readilyavailable.
Differential Diagnosis Based Upon Pathophysiology
- Eating disorders
- Magnesium over supplementation
- Prolonged use of medications/laxatives containing magnesium
- Absent parathyroid hormone (PTH)
- Hereditary hypoparathyroidism
- Acquired hypoparathyroidism
- Hypomagnesemia
- Following parathyroidectomy, "Hungry Bone Syndrome"
- Following thyroidectomy, the parathyroid glands are located very close to the thyroid and are easily injured or even accidentally removed during thyroidectomy
- Ineffective PTH
- Chronic renal failure
- Absent active vitamin D
- Decreased dietary intake
- Decreased sun exposure
- Defective Vitamin D metabolism
- Anticonvulsant therapy
- Vitamin-D dependent rickets, type I
- Ineffective active vitamin D
- Intestinal malabsorption
- Vitamin-D dependent rickets, type II
- Pseudohypoparathyroidism
- Deficient PTH
- Severe acute hyperphosphatemia
- Tumor lysis syndrome
- Acute renal failure
- Rhabdomyolysis (initial stage)
- Osteitis fibrosa following parathyroidectomy
- Severe acute hyperphosphatemia
- Exposure to hydrofluoric acid
- As a complication of pancreatitis
- As a result of hyperventilation.
- Chelation Therapy
Complete Differential Diagnosis of Hypocalcemia
In alphabetical order. [1] [1]
- Acute pancreatitis
- Adrenocortical hyperplasia
- Alcohol abuse
- Alkalosis
- Anticonvulsants
- Breast cancer
- Bronchial cancer
- Burns
- Chronic Renal Failure
- Cirrhosis
- Decreased ultraviolet/sun (vitamin D deficiency)
- DiGeorge's Syndrome
- Diuretic therapy
- Drugs
- Enemas, laxatives
- Enhanced bone formation
- Excessive secretion of calcitonin
- Familial hypocalcemia
- Hyperphosphatemia
- Hypoalbuminemia (pseudohypocalcemia)
- Hypomagnesiumia
- Hypoparathyroidism
- Hypoproteinemia
- Increased diuresis with physiologic saline solution
- Intravenous phosphate administration
- Kidney diseases with reduced formation of activated vitamin D
- Magnesium depletion
- Malabsorption
- Maldigestion
- Medullary carcinoma of the thyroid
- Neonatal tetany
- Nephrotic Syndrome
- Osteoblastic metastases
- Osteoporosis
- Polyglandular autoimmune syndrome
- Postoperative
- Pseudohypoparathyroidism
- Renal Failure
- Rhabdomyolysis
- Rickets
- Sepsis
- Septic shock
- Short Bowel Syndrome
- Steroid therapy
- Thyroid cancer
- Transfusion of citrated blood
- Tumor Lysis Syndrome
- Vitamin D deficiency
Diagnosis
History and Symptoms
- Fatigue
- Weakness
- Muscle cramping and spasm
- Nausea and vomiting
- Abdominal pain
- Depression
- Irritability
- Delirium
- Psychosis
- Seizures (with severe hypocalcemia)
- Perioral tingling and parasthesia, 'pins and needles' sensation over the extremities of hands and feet. This is the earliest symptom of hypocalcemia.
Signs
- Tetany, carpopedal spasm are seen.
- Latent tetany
- Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
- Chvostek's sign (tapping of the inferior portion of the zygoma will produce facial spasms)
- Tendon reflexes are hyperactive
- Life threatening complications
Laboratory Findings
Suggested initial laboratory studies include the following:
- Serum calcium
- Ionized calcium
- Complete blood count
- Blood urea nitrogen (BUN)/creatinine
- Magnesium
- Albumin
- Phosphorus
- Amylase/lipase
Additional laboratory studies to be obtained as part of a more complete evaluation include the following:
- Vitamin D levels
- Parathyroid hormone
Electrocardiographic Findings
- Prolongation of the QTc interval is the major EKG finding
- There is a lengthening of the interval between the end of the QRS and the beginning of the T wave (i.e. ST-segment lengthening).
EKG examples
Management
- Two ampoules of intravenous calcium gluconate 10% is given slowly in a period of 10 minutes, or if the hypocalcemia is severe, calcium chloride is given instead.
- Maintenance doses of both calcium and vitamin-D (often as 1,25-(OH)2-D3, i.e. calcitriol)) are often necessary to prevent further decline.
References
Acknowledgements
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
