Hypocalcemia: Difference between revisions
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**Positive = Ipsilateral facial twitching | **Positive = Ipsilateral facial twitching | ||
== | ==Differential Diagnosis== | ||
*Misc | |||
**[[Shock]] | |||
**[[Sepsis]] | |||
**[[Pancreatitis]] | |||
**[[Hypomag]] | |||
**[[Rhabdo]] (phosphate overload) | |||
**[[Massive transfusion]] | |||
*Decreased absorption | |||
**Vit D deficiency | |||
*Increased excretion | |||
**[[Alcoholism]] | |||
**[[Renal Failure]] | |||
**[[Diuretics]] | |||
*Endocrine | |||
**[[Hypoparathyroidism]] | |||
*Drugs | |||
**[[Cimetidine]] | |||
**[[Phenytoin]] | |||
**[[Lasix]] | |||
==Treatment== | ==Treatment== | ||
Revision as of 20:52, 20 January 2015
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
- Paresthesias (mouth, fingertips)
- Incr DTRs
- Cramps
- Weakness
- Confusion
- Seizures
- Chvostek/Trousseau, Tetany
- 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
- Misc
- Shock
- Sepsis
- Pancreatitis
- Hypomag
- Rhabdo (phosphate overload)
- Massive transfusion
- Decreased absorption
- Vit D deficiency
- Increased excretion
- Endocrine
- Drugs
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
Source
- Tintinalli