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

Differential Diagnosis

Jaw Spasms

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

Treatment

Avoid empiric treatment in patients taking digoxin due to risk for Stone Heart

  • Asymptomatic
    • Calcium gluconate 1 gm PO Q6hrs
    • Vitamin D (calcitriol) 0.2 mcg BID
  • Symptomatic
    • Calcium gluconate/chloride 10mL of 10% soln IV over 10min
  • Correct hypomag at same time (otherwise PTH is inhibited)

See Also

References