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{{Hypocalcemia}}
{{Hypocalcemia}}
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==Overview==
==Overview==
Clinical presentation of hypocalcemia reflects the serum level of ionized calcium and depends on the severity of any concurrent [[electrolyte imbalance]].<ref>{{cite book | last = Taal | first = Maarten | title = Brenner & Rector's the kidney | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2012 | isbn = 978-1416061939 }}</ref><ref>{{cite book | last = Johnson | first = Richard | title = Comprehensive clinical nephrology | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455758388 }}</ref>
Clinical presentation of [[hypocalcemia]] reflects the [[serum]] level of [[ionized]] [[calcium]] and depends on the severity of any concurrent [[electrolyte imbalance]]. Overt [[symptoms]] occur when ionized [[calcium]] falls below 3.2 mg/dL (0.8 mmol/L). An abrupt fall in the [[serum]] [[calcium]] level typically manifests as [[neuromuscular]] hyperexcitability in the form of [[tetany]] and [[tingling]].  Patients who develop hypocalcemia gradually may be asymptomatic. In addition to [[fatigue]] and [[muscle weakness]], longstanding hypocalcemia is usually associated with [[neuropsychiatric]] [[symptoms]].


Common manifestations of acute hypocalcemia include [[fatigue]], [[muscle weakness]], [[paresthesia]], [[tetany]], and neuropsychiatric disturbances.
==History and Symptoms==
The majority of patients with mild [[hypocalcemia]] are [[asymptomatic]]


==History and Symptoms==
===Common Symptoms===
Common symptoms of [[hypocalcemia]] include:<ref>{{Cite journal| doi = 10.1136/bmj.39582.589433.BE| issn = 1756-1833| volume = 336| issue = 7656| pages = 1298–1302| last1 = Cooper| first1 = Mark S.| last2 = Gittoes| first2 = Neil J. L.| title = Diagnosis and management of hypocalcaemia| journal = BMJ (Clinical research ed.)| date = 2008-06-07| pmid = 18535072| pmc = PMC2413335}}</ref><ref name="pmid2004255">{{cite journal |vauthors=Macefield G, Burke D |title=Paraesthesiae and tetany induced by voluntary hyperventilation. Increased excitability of human cutaneous and motor axons |journal=Brain |volume=114 ( Pt 1B) |issue= |pages=527–40 |date=February 1991 |pmid=2004255 |doi= |url=}}</ref><ref name="pmid23148147">{{cite journal |vauthors=Carroll R, Matfin G |title=Endocrine and metabolic emergencies: hypocalcaemia |journal=Ther Adv Endocrinol Metab |volume=1 |issue=1 |pages=29–33 |date=February 2010 |pmid=23148147 |pmc=3474611 |doi=10.1177/2042018810366494 |url=}}</ref><ref name="pmid18535072">{{cite journal |vauthors=Cooper MS, Gittoes NJ |title=Diagnosis and management of hypocalcaemia |journal=BMJ |volume=336 |issue=7656 |pages=1298–302 |date=June 2008 |pmid=18535072 |pmc=2413335 |doi=10.1136/bmj.39582.589433.BE |url=}}</ref>


===Symptoms===
'''Neuromuscular symptoms'''
* [[Tetany]]: which is [[hallmark]] of acute [[hypocalcemia]]
* [[Paresthesia|Paresthesias]] or [[tingling]]
* [[Muscle spasm|Muscle spasms]]: [[Muscle]] [[twitching]] and [[cramping]]


====Neuromuscular Irritability====
* [[Fatigue]]
* [[Laryngeal]] or [[bronchial]] [[spasm]]
* [[Laryngeal]] or [[bronchial]] [[spasm]]
* [[Muscle]] [[twitching]] and [[cramping]]
* [[Muscle weakness]]
* Circumoral and extremity [[paresthesia]] or [[tingling]]
* [[Tetany]]


====Central Nervous System Features====
====Central nervous system s'''ymptoms'''  ====
* [[Altered mental status]]
* [[Anxiety]]
* Emotional disturbance (eg, [[irritability]], [[depression]], [[psychosis]])
* [[Hallucination|Hallucinations]]
* [[Seizure]]
* [[Confusion]]
* [[Irritability]]
 
====Cardiovascular s'''ymptoms''' ====
* [[Bradycardia]]
* [[Ventricular]] [[arrhythmias]]
* [[Congestive heart failure]]


====Cardiovascular Features====
==== Pulmonary s'''ymptoms''' ====
* [[Hypotension]]
* [[Laryngeal]] [[stridor]]
* [[Bronchospasm]]


* Symptoms of [[congestive heart failure]]
==== Less common symptoms ====
Less common [[symptoms]] of [[hypocalcemia]] include<ref name="pmid231481472">{{cite journal |vauthors=Carroll R, Matfin G |title=Endocrine and metabolic emergencies: hypocalcaemia |journal=Ther Adv Endocrinol Metab |volume=1 |issue=1 |pages=29–33 |date=February 2010 |pmid=23148147 |pmc=3474611 |doi=10.1177/2042018810366494 |url=}}</ref>
* [[Cognitive]] deficits
* [[Extrapyramidal symptom|Extrapyramidal]] symptoms
* [[Dermatitis]]
* Dry skin
* [[Brittle nails|Brittle]] nails


==References==
==References==
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[[Category:Endocrinology]]
[[Category:Endocrinology]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Emergency medicine]]
 
[[Category:Blood tests]]
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Latest revision as of 11:56, 13 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Clinical presentation of hypocalcemia reflects the serum level of ionized calcium and depends on the severity of any concurrent electrolyte imbalance. Overt symptoms occur when ionized calcium falls below 3.2 mg/dL (0.8 mmol/L). An abrupt fall in the serum calcium level typically manifests as neuromuscular hyperexcitability in the form of tetany and tingling. Patients who develop hypocalcemia gradually may be asymptomatic. In addition to fatigue and muscle weakness, longstanding hypocalcemia is usually associated with neuropsychiatric symptoms.

History and Symptoms

The majority of patients with mild hypocalcemia are asymptomatic

Common Symptoms

Common symptoms of hypocalcemia include:[1][2][3][4]

Neuromuscular symptoms

Central nervous system symptoms

Cardiovascular symptoms

Pulmonary symptoms

Less common symptoms

Less common symptoms of hypocalcemia include[5]

References

  1. Cooper, Mark S.; Gittoes, Neil J. L. (2008-06-07). "Diagnosis and management of hypocalcaemia". BMJ (Clinical research ed.). 336 (7656): 1298–1302. doi:10.1136/bmj.39582.589433.BE. ISSN 1756-1833. PMC 2413335. PMID 18535072.
  2. Macefield G, Burke D (February 1991). "Paraesthesiae and tetany induced by voluntary hyperventilation. Increased excitability of human cutaneous and motor axons". Brain. 114 ( Pt 1B): 527–40. PMID 2004255.
  3. Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.
  4. Cooper MS, Gittoes NJ (June 2008). "Diagnosis and management of hypocalcaemia". BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
  5. Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.

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