Hypocalcemia natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
The clinical features of [[hypocalcemia]] may vary widely, | The clinical features of [[hypocalcemia]] may vary widely, and range from [[asymptomatic]] to life-threatening [[complications]].The main factors that influence [[serum]] [[calcium]] levels are [[parathyroid hormone]] ([[PTH]]), [[vitamin D]], ionized [[calcium]], and [[phosphate]]. [[Hypocalcemia]] is commonly encountered in patients who are hospitalized. Under treatment or improper treatment of hypocalcemic emergencies can lead to significant [[morbidity]]. Death is rare but has been reported in [[hypocalcemia]] patients. | ||
==Natural History== | ==Natural History== | ||
* The clinical presentation of hypocalcemia vary widely | * The clinical presentation of hypocalcemia may vary widely and range from [[asymptomatic]] to life-threatening complications.<ref name="pmid21841146">{{cite journal |vauthors=Kelly A, Levine MA |title=Hypocalcemia in the critically ill patient |journal=J Intensive Care Med |volume=28 |issue=3 |pages=166–77 |date=2013 |pmid=21841146 |doi=10.1177/0885066611411543 |url=}}</ref> | ||
* Parathyroid hormone (PTH), vitamin D, | * [[Parathyroid hormone]] ([[PTH]]), [[vitamin D]], ionized [[calcium]], and [[phosphate]] are the main regulators that influence [[serum]] [[calcium]] levels.<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><ref name="pmid25891861">{{cite journal |vauthors=Lee S, Mannstadt M, Guo J, Kim SM, Yi HS, Khatri A, Dean T, Okazaki M, Gardella TJ, Jüppner H |title=A Homozygous [Cys25]PTH(1-84) Mutation That Impairs PTH/PTHrP Receptor Activation Defines a Novel Form of Hypoparathyroidism |journal=J. Bone Miner. Res. |volume=30 |issue=10 |pages=1803–13 |date=October 2015 |pmid=25891861 |pmc=4580526 |doi=10.1002/jbmr.2532 |url=}}</ref><ref name="pmid8293350">{{cite journal |vauthors=Mizunashi K, Furukawa Y, Abe K, Yoshinaga K |title=The relationship between serum intact parathyroid hormone and calcium in idiopathic hypoparathyroidism |journal=Calcif. Tissue Int. |volume=53 |issue=6 |pages=378–83 |date=December 1993 |pmid=8293350 |doi= |url=}}</ref> | ||
* As the people age the calcium requirement also increases and risk for calcium deficiency also increases by age. | * As the people age the calcium requirement also increases and risk for calcium deficiency also increases by age. | ||
* Poor calcium intake,certain medications,dietary intolerance,hormonal changes and genetic factors may lead to hypocalcemia. | * Poor [[calcium]] intake, certain medications, dietary intolerance, [[hormonal]] changes and [[genetic]] factors may lead to hypocalcemia. | ||
==Complications== | ==Complications== | ||
* Common complications of hypocalcemia include<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="pmid9781172">{{cite journal |vauthors=Garabédian M |title=[Hypocalcemia] |language=French |journal=Rev Prat |volume=48 |issue=11 |pages=1201–6 |date=June 1998 |pmid=9781172 |doi= |url=}}</ref><ref name="pmid7808098">{{cite journal |vauthors=Reber PM, Heath H |title=Hypocalcemic emergencies |journal=Med. Clin. North Am. |volume=79 |issue=1 |pages=93–106 |date=January 1995 |pmid=7808098 |doi= |url=}}</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="pmid26923551">{{cite journal |vauthors=Thurlow JS, Yuan CM |title=Dialysate-induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations |journal=Hemodial Int |volume=20 |issue=2 |pages=E8–E11 |date=April 2016 |pmid=26923551 |doi=10.1111/hdi.12386 |url=}}</ref><ref name="pmid4014262">{{cite journal |vauthors=Levine SN, Rheams CN |title=Hypocalcemic heart failure |journal=Am. J. Med. |volume=78 |issue=6 Pt 1 |pages=1033–5 |date=June 1985 |pmid=4014262 |doi= |url=}}</ref><ref name="pmid2382615">{{cite journal |vauthors=Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B |title=Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement |journal=Am. Heart J. |volume=120 |issue=2 |pages=381–6 |date=August 1990 |pmid=2382615 |doi= |url=}}</ref><ref name="pmid1633370">{{cite journal |vauthors=Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O |title=Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism |journal=Intern. Med. |volume=31 |issue=4 |pages=561–8 |date=April 1992 |pmid=1633370 |doi= |url=}}</ref><ref name="pmid942827">{{cite journal |vauthors=Denlinger JK, Nahrwold ML |title=Cardiac failure associated with hypocalcemia |journal=Anesth. Analg. |volume=55 |issue=1 |pages=34–6 |date=1976 |pmid=942827 |doi= |url=}}</ref><ref name="pmid26015274">{{cite journal |vauthors=Brunelli SM, Sibbel S, Do TP, Cooper K, Bradbury BD |title=Facility Dialysate Calcium Practices and Clinical Outcomes Among Patients Receiving Hemodialysis: A Retrospective Observational Study |journal=Am. J. Kidney Dis. |volume=66 |issue=4 |pages=655–65 |date=October 2015 |pmid=26015274 |doi=10.1053/j.ajkd.2015.03.038 |url=}}</ref><ref name="pmid2632508">{{cite journal |vauthors=Gupta MM |title=Medical emergencies associated with disorders of calcium homeostasis |journal=J Assoc Physicians India |volume=37 |issue=10 |pages=629–31 |date=October 1989 |pmid=2632508 |doi= |url=}}</ref> | * Common [[complications]] of hypocalcemia include<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="pmid9781172">{{cite journal |vauthors=Garabédian M |title=[Hypocalcemia] |language=French |journal=Rev Prat |volume=48 |issue=11 |pages=1201–6 |date=June 1998 |pmid=9781172 |doi= |url=}}</ref><ref name="pmid7808098">{{cite journal |vauthors=Reber PM, Heath H |title=Hypocalcemic emergencies |journal=Med. Clin. North Am. |volume=79 |issue=1 |pages=93–106 |date=January 1995 |pmid=7808098 |doi= |url=}}</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="pmid26923551">{{cite journal |vauthors=Thurlow JS, Yuan CM |title=Dialysate-induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations |journal=Hemodial Int |volume=20 |issue=2 |pages=E8–E11 |date=April 2016 |pmid=26923551 |doi=10.1111/hdi.12386 |url=}}</ref><ref name="pmid4014262">{{cite journal |vauthors=Levine SN, Rheams CN |title=Hypocalcemic heart failure |journal=Am. J. Med. |volume=78 |issue=6 Pt 1 |pages=1033–5 |date=June 1985 |pmid=4014262 |doi= |url=}}</ref><ref name="pmid2382615">{{cite journal |vauthors=Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B |title=Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement |journal=Am. Heart J. |volume=120 |issue=2 |pages=381–6 |date=August 1990 |pmid=2382615 |doi= |url=}}</ref><ref name="pmid1633370">{{cite journal |vauthors=Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O |title=Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism |journal=Intern. Med. |volume=31 |issue=4 |pages=561–8 |date=April 1992 |pmid=1633370 |doi= |url=}}</ref><ref name="pmid942827">{{cite journal |vauthors=Denlinger JK, Nahrwold ML |title=Cardiac failure associated with hypocalcemia |journal=Anesth. Analg. |volume=55 |issue=1 |pages=34–6 |date=1976 |pmid=942827 |doi= |url=}}</ref><ref name="pmid26015274">{{cite journal |vauthors=Brunelli SM, Sibbel S, Do TP, Cooper K, Bradbury BD |title=Facility Dialysate Calcium Practices and Clinical Outcomes Among Patients Receiving Hemodialysis: A Retrospective Observational Study |journal=Am. J. Kidney Dis. |volume=66 |issue=4 |pages=655–65 |date=October 2015 |pmid=26015274 |doi=10.1053/j.ajkd.2015.03.038 |url=}}</ref><ref name="pmid2632508">{{cite journal |vauthors=Gupta MM |title=Medical emergencies associated with disorders of calcium homeostasis |journal=J Assoc Physicians India |volume=37 |issue=10 |pages=629–31 |date=October 1989 |pmid=2632508 |doi= |url=}}</ref> | ||
** Bone disease | ** [[Bone]] disease such as: | ||
*** Osteoporosis, | *** [[Osteoporosis]], complications from [[osteoporosis]] include | ||
**** | **** [[Fractures]] | ||
**** Disability | **** [[Disability]] | ||
** Cardiovascular collapse with [[ | ** [[Cardiovascular]] collapse with [[cardiac arrhythmia]] | ||
*** The ECG hallmark of hypocalcaemia is prolongation of the corrected QT interval. | *** The [[ECG]] hallmark of hypocalcaemia is prolongation of the [[corrected QT interval]]. | ||
** Hypocalcemic cardiomyopathy | ** Hypocalcemic [[cardiomyopathy]] | ||
** Hypotension which is unresponsive to fluids and vasopressors | ** [[Hypotension]] which is unresponsive to fluids and [[vasopressors]] | ||
** Dysrhythmias | ** [[Dysrhythmias]] | ||
** [[Laryngospasm]] | ** [[Laryngospasm]] | ||
** Seizures | ** [[Seizures]] | ||
** Tetany | ** [[Tetany]] | ||
** Basal ganglia calcification | ** [[Basal ganglia]] [[calcification]] | ||
** Parkinsonism | ** [[Parkinsonism]] | ||
** Hemiballismus | ** [[Hemiballismus]] | ||
** Choreoathetosis | ** [[Choreoathetosis]] | ||
** Intradialytic hypotension | ** Intradialytic hypotension | ||
==Prognosis== | ==Prognosis== | ||
* [[Prognosis]] is generally good when [[hypocalcemia]] treated | * [[Prognosis]] is generally good when [[hypocalcemia]] treated optimally. | ||
* The [[Concentration|concentrations]] of [[ionized]] [[calcium]] on day 3 could be very useful for the [[prediction]] of [[mortality]] and [[disability]] in patients with moderate and severe [[Traumatic brain injury|traumatic]] | * The [[Concentration|concentrations]] of [[ionized]] [[calcium]] on day 3 could be very useful for the [[prediction]] of [[mortality]] and [[disability]] in patients with moderate and severe [[Traumatic brain injury|traumatic brain injury]] ([[Traumatic brain injury|TBI]]).<ref name="pmid26396605">{{cite journal |vauthors=Manuel VR, Martin SA, Juan SR, Fernando MA, Frerk M, Thomas K, Christian H |title=Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury |journal=Asian J Neurosurg |volume=10 |issue=3 |pages=190–4 |date=2015 |pmid=26396605 |pmc=4553730 |doi=10.4103/1793-5482.161171 |url=}}</ref><ref name="pmid24139087">{{cite journal |vauthors=Vinas-Rios JM, Sanchez-Aguilar M, Sanchez-Rodriguez JJ, Gonzalez-Aguirre D, Heinen C, Meyer F, Kretschmer T |title=Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury |journal=Neurol. Res. |volume=36 |issue=2 |pages=102–6 |date=February 2014 |pmid=24139087 |doi=10.1179/1743132813Y.0000000272 |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 11:53, 13 August 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
The clinical features of hypocalcemia may vary widely, and range from asymptomatic to life-threatening complications.The main factors that influence serum calcium levels are parathyroid hormone (PTH), vitamin D, ionized calcium, and phosphate. Hypocalcemia is commonly encountered in patients who are hospitalized. Under treatment or improper treatment of hypocalcemic emergencies can lead to significant morbidity. Death is rare but has been reported in hypocalcemia patients.
Natural History
- The clinical presentation of hypocalcemia may vary widely and range from asymptomatic to life-threatening complications.[1]
- Parathyroid hormone (PTH), vitamin D, ionized calcium, and phosphate are the main regulators that influence serum calcium levels.[2][3][4]
- As the people age the calcium requirement also increases and risk for calcium deficiency also increases by age.
- Poor calcium intake, certain medications, dietary intolerance, hormonal changes and genetic factors may lead to hypocalcemia.
Complications
- Common complications of hypocalcemia include[5][6][7][8][9][10][11][12][13][14][15]
- Bone disease such as:
- Osteoporosis, complications from osteoporosis include
- Cardiovascular collapse with cardiac arrhythmia
- The ECG hallmark of hypocalcaemia is prolongation of the corrected QT interval.
- Hypocalcemic cardiomyopathy
- Hypotension which is unresponsive to fluids and vasopressors
- Dysrhythmias
- Laryngospasm
- Seizures
- Tetany
- Basal ganglia calcification
- Parkinsonism
- Hemiballismus
- Choreoathetosis
- Intradialytic hypotension
- Bone disease such as:
Prognosis
- Prognosis is generally good when hypocalcemia treated optimally.
- The concentrations of ionized calcium on day 3 could be very useful for the prediction of mortality and disability in patients with moderate and severe traumatic brain injury (TBI).[16][17]
References
- ↑ Kelly A, Levine MA (2013). "Hypocalcemia in the critically ill patient". J Intensive Care Med. 28 (3): 166–77. doi:10.1177/0885066611411543. PMID 21841146.
- ↑ 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.
- ↑ Lee S, Mannstadt M, Guo J, Kim SM, Yi HS, Khatri A, Dean T, Okazaki M, Gardella TJ, Jüppner H (October 2015). "A Homozygous [Cys25]PTH(1-84) Mutation That Impairs PTH/PTHrP Receptor Activation Defines a Novel Form of Hypoparathyroidism". J. Bone Miner. Res. 30 (10): 1803–13. doi:10.1002/jbmr.2532. PMC 4580526. PMID 25891861.
- ↑ Mizunashi K, Furukawa Y, Abe K, Yoshinaga K (December 1993). "The relationship between serum intact parathyroid hormone and calcium in idiopathic hypoparathyroidism". Calcif. Tissue Int. 53 (6): 378–83. PMID 8293350.
- ↑ 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.
- ↑ Garabédian M (June 1998). "[Hypocalcemia]". Rev Prat (in French). 48 (11): 1201–6. PMID 9781172.
- ↑ Reber PM, Heath H (January 1995). "Hypocalcemic emergencies". Med. Clin. North Am. 79 (1): 93–106. PMID 7808098.
- ↑ 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.
- ↑ Thurlow JS, Yuan CM (April 2016). "Dialysate-induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations". Hemodial Int. 20 (2): E8–E11. doi:10.1111/hdi.12386. PMID 26923551.
- ↑ Levine SN, Rheams CN (June 1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.
- ↑ Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B (August 1990). "Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement". Am. Heart J. 120 (2): 381–6. PMID 2382615.
- ↑ Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (April 1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.
- ↑ Denlinger JK, Nahrwold ML (1976). "Cardiac failure associated with hypocalcemia". Anesth. Analg. 55 (1): 34–6. PMID 942827.
- ↑ Brunelli SM, Sibbel S, Do TP, Cooper K, Bradbury BD (October 2015). "Facility Dialysate Calcium Practices and Clinical Outcomes Among Patients Receiving Hemodialysis: A Retrospective Observational Study". Am. J. Kidney Dis. 66 (4): 655–65. doi:10.1053/j.ajkd.2015.03.038. PMID 26015274.
- ↑ Gupta MM (October 1989). "Medical emergencies associated with disorders of calcium homeostasis". J Assoc Physicians India. 37 (10): 629–31. PMID 2632508.
- ↑ Manuel VR, Martin SA, Juan SR, Fernando MA, Frerk M, Thomas K, Christian H (2015). "Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury". Asian J Neurosurg. 10 (3): 190–4. doi:10.4103/1793-5482.161171. PMC 4553730. PMID 26396605.
- ↑ Vinas-Rios JM, Sanchez-Aguilar M, Sanchez-Rodriguez JJ, Gonzalez-Aguirre D, Heinen C, Meyer F, Kretschmer T (February 2014). "Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury". Neurol. Res. 36 (2): 102–6. doi:10.1179/1743132813Y.0000000272. PMID 24139087.