Hypocalcaemia

Hypocalcaemia is defined as a corrected Ca < 2.1 mmol/L. It's important to adjust calcium to albumin levels as hypoalbuminaemia may cause apparant hypocalcaemia (look calcium and phosphate control notes). The causes of this are:

• Hypoparathyroidism

• Vit D deficiency

• Hypomagnesaemia

• Acute pancreatitis

• Malabsorption

• Hypomagnesaemia

Presentation

SPASMODIC:

• Spasms - Trousseau’s sign (arm) - spasm of hand by inflation of BP cuff above systolic pressure for 3 minutes

• Perioral paraesthesia

• Anxiety, irritability

• Seizures

• Muscle tone increase (colic, dysphagia)

• Orientation impairment (confusion)

• Dermatitis

• Impetigo herpetiformis

• Chvostek’s sign (face) - contraction of ipsilateral facial muscles elicited by tapping the facial nerve just anterior to the ear

Investigations

• ECG - Prolonged QT interval, Osborn wave

• Bloods - Vit D, Mg, Amylase

• Bone profile - Ca, pH, PTH, Albumin, ALP

Management

Acute:

• Mild - PO Calcium Carbonate

• Severe (Spasms/ECG changes) - IV Calcium Gluconate

Long-term:

• Treat underlying cause

• Improve dietary intake

• Supplementation