This document discusses hypocalcemia, which occurs when calcium levels in the blood are too low. It defines normal calcium levels and describes the causes of hypocalcemia, including kidney disease, hypoparathyroidism, vitamin D deficiency, certain drugs, and other conditions. Symptoms can include tingling, muscle cramps, seizures, and cardiac issues. Diagnosis involves testing serum calcium, phosphate, albumin, magnesium, parathyroid hormone, and vitamin D levels. Treatment depends on severity but may include oral calcium supplements or intravenous calcium for more severe cases.

1. Hypocalcaemia
Amarendra B Singh
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2. Calcium
Normal total calcium level is 8.5 -10.5mg/dl
Normal ionized Ca+2 level is 4.5 – 5.6mg/dl
Hypocalcaemia
Total calcium <8.5 mg/dL, if serum protein is
normal
OR
Ionized calcium < 4.5mg/dL
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3. Role of Mg
• Always measure serum magnesium in a
hypocalcaemic patient.
• Hypomagnesemia impairs PTH secretion
• It also causes resistance to the actions of
PTH at the level of kidney and bone
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7. Causes of hypocalcaemia
1) Increased Phosphate levels
– Chronic kidney disease
– Phosphate therapy
2) Hypoparathyroidism
– Post thyroidectomy hypocalcaemia
– Congenital deficiency (Di George Syndrome)
– Idiopathic hypoparathyroidism
– Severe hypomagnesaemia
3) Vitamin D deficiency
– Osteomalacia/rickets
– Vitamin D resistance
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8. Causes of hypocalcaemia
4). Resistance to PTH
– Pseudohypoparathyroidism
5). Drugs
– Calcitonins
– Bisphosphanates
6). Other
– Acute pancreatitis
– Citrate blood in massive transfusion
– Low plasma albumin eg. Malnutrition, Chronic liver
disease
– Malabsorption eg. Coeliac disease
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9. Clinical Features
• The clinical manifestations of hypocalcaemia result
from increased neuromuscular irritability.
• Paraesthesia (tingling sensation) around mouth,
fingers and toes
• Muscle cramps, carpopedal spasms
• Tetany
• Seizures – focal or generalised
• Laryngospasm, stridor and apnoeas (neonates)
• Cardiac rhythm disturbances (prolonged QT interval)
• Chvostek’s and Trousseau’s signs – latent
hypocalcemia
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10. Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins,
www.wrongdiagnosis.com/bookimages/14/4721.1.png
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11. Trousseau sign:
(very uncomfortable and painful)
• A blood pressure cuff is inflated to 20mm Hg above systolic blood
pressure level.
• arterial blood flow to the hand is occluded for 3 to 5 minutes.
• Carpopedal spasm:
* flexion at the wrist
* flexion at the MCP joints
* extension of the IP joints
* adduction thumbs/fingers
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12. Investigations
• S. Calcium and Phosphate levels
• S. Albumin
• S. & Urinary Creatinine (for renal disease)
• PTH levels in serum
• Parathyroid antibodies (present in idiopathic
hypoparathyroidism)
• Vitamin D serum level (low in Vitamin D def.)
• Magnesium level
• X-rays of metacarpals (showing short 4th
metacarpals which occur in pseudo
hypoparathyroidism)
• ECG
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13. Pseudohypoparathyroidism
• Phenotype of
Albright’s
• NORMAL serum
calcium
• NO PTH
resistance
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15. Management
1. Dependent on the underlying cause and
severity
2. Administration of calcium alone is only
transiently effective.
3. Mild asymptomatic cases: Often adequate to
increase dietary calcium by 1000 mg/day
4. Symptomatic: Treat immediately22/06/2013 Hypocalcaemia 15

16. Severe Symptomatic:
• IV 10% Calcium Gluconate 10 ml over 10 minutes
• Continuous IV infusion of Calcium Gluconate @ 0.1
mmol/kg over 24 hours
• Continuous Cardiac monitoring for Bradycardia
Severe Asymptomatic:
Oral Calcium Supplements @ 0.2 mmol/kg
(Max 10 mmols or 400 mg Ca) 4 x a day
Treatment of Hypocalcaemia
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17. • Aim to keep serum Ca between 8-8.5mg/dl
• Oral Calcium supplements
• Active preparations of Vitamin D
• 1,25-dihydroxyvitamin D (Calcitriol)
• 1-α-hydroxyvitamin D (Alfacalcidiol) @ 50
nanograms/kg (Max ~2 micrograms/day)
• Monitoring
• Urine Ca/Cr (<0.7)
• Plasma Ca+2
Treatment of
Hypoparathyroidism
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18. Thank You!
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