Neurological Manifestation of Hypocalcemia

1. A D E W I J A Y A , M D – F E B R U A R Y 2 0 2 2
Neurological Manifestation of
Hypocalcemia

2. Outline:
 Calcium homeostasis
 Clinical features
 Etiology
 Diagnosis
 Treatment

3. Calcium Homeostasis

4. Neurological Clinical Features
Schafer AL and Shoback D: Hypocalcemia: definition, etiology, pathogenesis, diagnosis and management. Primer on the Metabolic Bone Diseases and Disorders of
Mineral Metabolism, C. J. Rosen (ed), John Wiley and Sons, Eighth Edition. pp 572-578, 2013.

5. Other Clinical Features
 Altered mental status
 Ectodermal changes
 Smooth muscle involvement
 Opthalmologic manifestation
 Cardiac involvement
Schafer AL and Shoback D: Hypocalcemia: definition, etiology, pathogenesis, diagnosis and management. Primer on the Metabolic Bone Diseases and Disorders of
Mineral Metabolism, C. J. Rosen (ed), John Wiley and Sons, Eighth Edition. pp 572-578, 2013.

6. Etiology
 Inadequate vitamin D production and action
 Inadequate PTH production/Hypoparathyroidism
 Functional hypoparathyroidism
 PTH resistance
 Miscellaneous
Schafer AL, Shoback, D: Hypocalcemia: definition, etiology, pathogenesis, diagnosis and management. Primer on the Metabolic Bone Diseases and Disorders of Mineral
Metabolism, C. J. Rosen (ed), John Wiley and Sons, Eighth edition, pp 572-578, 2013.

7. Diagnosis
Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, Occhiuto M, Piazzolla V, De Martino V, Ferrone F, Minisola S. Diagnosis
and management of hypocalcemia. Endocrine. 2020 Sep;69(3):485-95.

8. Treatment (Acute)
 Calcium gluconate contains 90 mg of elemental calcium
per 10 mL ampule, and usually 1 to 2 ampules (180 mg of
elemental calcium) diluted in 50 to 100 mL of 5%
dextrose is infused over 10 minutes. This can be repeated
until the patient's symptoms have cleared
 Drip rates of 0.5-2.0 mg/kg/hour
 Oral calcium supplementation with vitamin D or its
analogue
Notes: watch for arrhytmia, local vein irritation,
calcifications, calcium phosphate deposition.
Schafer AL, Shoback DM. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South
Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279022/

9. Treatment (Chronic)
 Oral calcium and vitamin D
 An activated vitamin D metabolite such as calcitriol
 PTH replacement
Schafer AL, Shoback DM. Hypocalcemia: Diagnosis and Treatment. [Updated 2016 Jan 3]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South
Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279022/

10. Summary
 Acute vs chronic
 Acute: life threatening
 The hallmark of acute hypocalcemia is
neuromuscular irritability
 Related to hypoparathyroidism
 Treament:
- Acute: IV calcium gluconate
- Chronic: oral calcium with vitamin D

11. THANK YOU