Hypocalcemia: Difference between revisions

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* [[Drugs]]
* [[Drugs]]
* [[Eating disorders]]
* [[Eating disorders]]
* Enemas, laxatives
* [[Enemas]], [[laxative]]s
* Enhanced bone formation
* Enhanced [[bone]] formation
* Excessive secretion of calcitonin
* Excessive secretion of calcitonin
* Exposure to [[hydrofluoric acid]]
* Exposure to [[hydrofluoric acid]]
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* Following [[thyroidectomy]]
* Following [[thyroidectomy]]
* Hereditary [[hypoparathyroidism]]
* Hereditary [[hypoparathyroidism]]
*  "Hungry Bone Syndrome"following [[parathyroidectomy]],
*  "Hungry Bone Syndrome" following [[parathyroidectomy]],
* [[Hyperphosphatemia]]
* [[Hyperphosphatemia]]
*  [[Hyperventilation]].
*  [[Hyperventilation]].
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* [[Magnesium]] depletion
* [[Magnesium]] depletion
* [[Magnesium]] over supplementation
* [[Magnesium]] over supplementation
* Malabsorption
* [[Malabsorption]]
* Maldigestion
* Mal[[digestion]]
* [[Medullary carcinoma of the thyroid]]
* [[Medullary carcinoma of the thyroid]]
* Neonatal tetany
* Neonatal tetany
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* [[Osteoporosis]]
* [[Osteoporosis]]
* [[Pancreatitis]]
* [[Pancreatitis]]
* Polyglandular autoimmune syndrome
* Polyglandular [[autoimmune]] syndrome
* Postoperative
* Postoperative
* Prolonged use of medications/laxatives containing [[magnesium]]
* Prolonged use of medications/laxatives containing [[magnesium]]
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* Severe acute [[hyperphosphatemia]]
* Severe acute [[hyperphosphatemia]]
* [[Short bowel syndrome]]
* [[Short bowel syndrome]]
* Steroid therapy
* [[Steroid]] therapy
* [[Thyroid cancer]]
* [[Thyroid cancer]]
* [[Transfusion]] of citrated blood
* [[Transfusion]] of citrated blood

Revision as of 14:13, 26 January 2009

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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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 readily available.

Alkalosis

As blood plasma hydrogen ion concentration decreases, caused by respiratory or metabolic alkalosis, freely ionized calcium concentration decreases. This freely ionized calcium is the biologically active component of blood calcium. Since a portion of both hydrogen ions and calcium are bound to serum albumin, when blood becomes alkalotic, bound hydrogen ions dissociate from albumin, freeing up the albumin to bind with more calcium and thereby decreasing the freely ionized portion of total serum calcium. For every 0.1 increase in pH, ionized calcium decreases by about 0.05 mmol/l.

This hypocalcemia related to alkalosis is partially responsible for the cerebral vasoconstriction that causes the lightheadedness, fainting, and parasthesia often seen with hyperventilation.

Causes

Complete Differential Diagnosis of the Causes of Hypocalcemia

(In alphabetical order)

Complete Differential Diagnosis of the Causes of Hypocalcemia

(By organ system)

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes



Diagnosis

History and Symptoms

Signs

Clinical Features Associated with Hypocalcemia

Laboratory Findings

Suggested initial laboratory studies include the following:

Additional laboratory studies to be obtained as part of a more complete evaluation include the following:

Electrocardiographic Findings

  1. Prolongation of the QTc interval is the major EKG finding
  2. 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

Prolonged QTc interval due to hypocalcemia


Management

References

See also

External links

Acknowledgements

The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.

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