Updated: 6/18/2021

Hypocalcemia

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https://upload.orthobullets.com/topic/9027/images/pphpth xray.jpg
https://upload.orthobullets.com/topic/9027/images/basal ganglia calcification.jpg
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  • causes of hypocalcemia
    • Causes of hypocalcemia include
      • decreased PTH that can be caused by
        • hypoparathyrodism
        • pseudohypoparathyroidism
        • renal osteodystrophy
      • decreased vitamin D3
  • Presentation
    • Symptom
      • symptoms of hypocalcemia
        • paresthesia
          • fingertip, toes, perioral
        • abdominal pain, biliary colic
        • muscle cramps, tetany
        • dyspnea (laryngospasm, bronchospasm)
        • convulsions
        • mental status changes
          • anxiety, fatigue, mood swings
    • Physical exam
      • findings of tetany
        • Trousseau's Sign
          • carpopedal spasm after blood pressure readings
            • inflate BP cuff 20mmHg above systolic BP x 3-5min
          • hand adopts a MCP flexed, DIP and PIP extended position
          • more sensitive than Chvostek's sign
        • Chvostek's Sign
          • facial muscle contractions after tapping on the facial nerve
      • dermatologic
        • fungal nail infections
        • hair loss
        • blotchy skin
          • pigment loss, vitiligo
  • Radiographs
    • Basal ganglia calcification
      • comprises striatum, globus pallidus, substantia nigra, subthalamic nucleus
  • Evaluation
    • Serum calcium, phosphate, vit D, PTH
    • Serum albumin
      • low serum albumin (low protein) leads to low total calcium
        • but ionized calcium levels will be normal
    • pH
      • alkalosis increases albumin binding to ionized calcium
        • leads to hypocalcemia
    • EKG
      • prolonged QT interval
    • Labs associated with various PTH, and Vitamin D anomalies
      Serum Ca
      Serum Phos
      PTH
      Common Cause
      Hyperparathyroidism
      Increased
      Decreased
      Increased
      Adenoma
      Hypoparathyroidism
      Decreased
      Increased
      Decreased
      Parathyroidectomy
      Ectopic PTH
      Increased
      Decreased
      Decreased
      Malignancy
      Vitamin D malabsorption
      Decreased
      Decreased
      Increased
      Celiac disease, other GI disease
      Hypo Vit D with no phosphate excretion from the kidney.
      Decreased
      Increased
      Increased
      Renal failure, pseudo
      hypoparathyroidism
  • Treatment
    • Nonoperative
      • calcium gluconate infusion
        • with cardiac monitoring to prevent hypercalcemia)
      • activated vitamin D (calcitriol)

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