Introduction 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 Serum Ca Serum Phos PTH Common Cause Hyperparathyroidism ↑ ↓ ↑ adenoma Hypoparathyroidism ↓ ↑ ↓ parathyroidectomy Ectopic PTH ↑ ↓ ↓ malignancy Vit D malabsorption ↓ ↓ ↑ celiac disease, other GI isease Hypo vit D with no phosphate excretion from the kidney. ↓ ↑ ↑ renal failure, pseudohypoparathyroidism Treatment Nonoperative calcium gluconate infusion with cardiac monitoring to prevent hypercalcemia) activated vitamin D (calcitriol)
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