Electrolyte imbalances

1. HYPOCALCEMIA
 Low calcium levlels <2.1mmol/L
 Dietary calcium is absorbed in the small intestine and exists through the
kidneys
 About 99% of calcium is located in bones and the rest in the body fluids
 Regulation of calcium is mainly by PTH and calcitriol (active vitamin D) and to
a lesser extent calcitonin
 Calcitriol is produced by the kidney
 Etiology
 Decreased PTH

2.  Total serum calcium=free ironized calcium(physiologically active form of
calcium and calcium bound to albumin)
 Because of this, in case of hypoalbuminemia, total serum calcium may appear
low but physiologically active form may be normal hence need to correct
hypoalbuminemia in case of hypocalcemia
 High blood PH(alkalemia) causes more calcium to be bound to albumin,
leaving less free calcium whiles total calcium level may appear normal

3. Etiology
 PTH defeciency
Causes may be:
Damage during surgery
Autoimmune disorders
Underdeveloped/ non-functional glands – DiGeorge syndrom
Magnessium defeciency(as it is needed for synthesis of PTH
 Low Vit D (diet, malabsorbtion in small intestine, lack of sunlight, cirrhosis,
renal failure)
 Loss of Calcium(Kidney disease, tissue injury, GIT diseases)

4. Signs and Symptoms
 Chronic Moderate may be assymptomatic
 Acute Severe may be life threatening
 Because extracellular calcium inhibit sodium channels, decrease levels means
unopossed opening of sodium channels hence depolarization
 This increases neuronal excitability and muscle spasms
 Symptoms will include numbness, tingling of mouth, fingers and toes
 Wheezing (spasm of bronchial muscles) and Tetany(spasm of limb muscle)
 Spasm of swallowing muscles(Dysphagia) and vocal cord spasms(voice change)
 Seizures

5. Effect of heart
 Long QT
 Congestive heart failure
 Hypotension

6. Treatment
 Acute Hypocalcemia should be treated with IV Calcium gluconate( is preferred
over calcium chloride)
 Chronic should be treated with oral calcium and Vit D