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

Clinical Features

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

Diagnosis

DDX

  1. Misc
    1. Shock
    2. Sepsis
    3. Pancreatitis
    4. Hypomag
    5. Rhabdo (phosphate overload)
    6. Massive Transfusion
  2. Decreased absorption
    1. Vit D def
  3. Increased excretion
    1. Alcoholism
    2. Renal Failure
    3. Diuretics
  4. Endocrine
    1. Hypoparathyroidism
  5. Drugs
    1. Cimetidine
    2. Phenytoin
    3. Lasix

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

  • Tintinalli