Hypocalcemia

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Background

  • Low <8.5 (<2.0 ionized)
  • Low! <6.5 (<1.5 ionized)
  • Correct for hypoalbumimia
    • Corrected Ca = (0.8 * (Normal Alb - Pt's Alb)) + Serum Ca

Causes

Clinical Features

  1. Paresthesias (mouth, fingertips)
  2. Incr DTRs
  3. Cramps
  4. Weakness
  5. Confusion
  6. Seizures
  7. Chvostek/Trousseau, Tetany
  8. Hallucinations

Diagnosis

  • Trousseau's Sign (Mod to high SN and SP)
    • Inflate BP cuff for 2-3 mins
    • Positive = Muscle contractions of the hand and wrist
  • Chvostek's Sign (Low SN and SP)
    • Tapping on the face just anterior to the ear and just below the zygomatic bone
    • Positive = Ipsilateral facial twitching

Differential Diagnosis

Jaw Spasms

Treatment

  • Avoid empiric treatment in patients taking digoxin due to risk for Stone Heart
  1. Asymptomatic
    1. Calcium gluconate 1 gm PO Q6hrs
    2. Vitamin D (calcitriol) 0.2 mcg BID
  2. Symptomatic
    1. Calcium gluconate/chloride 10mL of 10% soln IV over 10min
  • Correct hypomag at same time (otherwise PTH is inhibited)

See Also

Source