Updated: 10/10/2016

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
https://upload.orthobullets.com/topic/9027/images/prolonged qt.jpg
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 post
        • 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 post
        • 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, pseudo
hypoparathyroidism
 
Treatment
  • Nonoperative
    • calcium gluconate infusion
      • with cardiac monitoring to prevent hypercalcemia)
    • activated vitamin D (calcitriol)
 

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