Diferencia entre revisiones de «Hypocalcemia»
 
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==Background==
==Background==  
*Low <8.5 (<2.0 ionized)
===Serum Levels===
*Low! <6.5 (<1.5 ionized)
''Normal value ranges may vary slightly among different laboratories''
*Low: <8.9 mg/dL<ref>Harbor-UCLA computer system accessed 08/15/2019</ref> (Ionized: <4.8 mg/dL or <1.20 millimol/L<ref>https://www.ucsfhealth.org/tests/003486.html</ref>)
*Critical low: <6.6 mg/dL<ref>Harbor-UCLA computer system accessed 08/15/2019</ref> (Ionized: <3.5 mg/dL<ref>http://www.clinlabnavigator.com/calcium-ionized.html</ref>)
 


*Correct for hypoalbumimia
*Correct for hypoalbumimia
**Corrected Ca = (0.8 * (Normal Alb - Pt's Alb)) + Serum Ca
**Corrected Ca = (0.8 *(Normal Alb - Patient's Alb)) + Serum Ca
 
===Fraction<ref>Yu, AS. Relation between total and ionized serum calcium concentrations. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on October 6th, 2016.)</ref>===
*15% bound to anions (phosphate, lactate, citrate)
*40% bound to albumin
*45% free (regulated by PTH, Vit-D)
 
===Causes===
*Misc
**[[Shock]]
**[[Sepsis]]
**[[Pancreatitis]]
**[[Hypomag]]
**[[Rhabdo]] (phosphate overload)
**[[Massive transfusion]]
**Systemic [[Hydrofluoric Acid]] toxicity
**[[DiGeorge syndrome]]
*Decreased absorption
**[[Vitamin D deficiency]]
*Increased excretion
**[[Alcoholism]]
**[[Renal Failure]]
**[[Diuretics]]
*Endocrine
**[[Hypoparathyroidism]]
*Drugs
**[[Cimetidine]]
**[[Phenytoin]]
**[[Lasix]], loop diuretics
**[[Norepinephrine]]
**[[Glucagon]]
**[[Glucocorticoids]]
**[[Magnesium sulfate]]
**[[Nitroprusside]]
 
==Clinical Features==
{{Hypocalcemia clinical features}}
 
==Differential Diagnosis==
{{Movement disorder DDX}}
{{Jaw spasms DDX}}
 
==Evaluation==
===[[ECG]]===
[[File:ECG.png|thumbnail|Hypocalcemia with QTc prolongation]]
*[[QT Prolongation]] via increasing the ST length
**Only hypothermia and hypocalcemia prolong QT this way
===Trousseau's sign===
[[File:Hypocalcemia spasm.jpg|thumbnail|Spasm associated with symptomatic hypocalcemia]]
*Inflate BP cuff for 2-3 minutes
*Positive = Muscle contractions of the hand and wrist
*Specificity 99%, sensitivity 94%
 
===Chvostek sign ===
*Tapping on the face just anterior to the ear and just below the zygomatic bone
*Positive = Ipsilateral facial twitching
*Specificity 96%, sensitivity 26%
 
===Labs===
*BMP
*Mag, Phos
*PTH (secondary hyperparathyroidism)


==Diagnosis==
==Management==
Signs/Symptoms
''Avoid empiric treatment in patients taking [[digoxin]] due to risk for [[Stone Heart]]''
#Paresthesias
*Asymptomatic
#Inc DTRs
**[[Calcium gluconate]] 1 gm PO Q6hrs
#Cramps
**Vitamin D (calcitriol) 0.2 mcg BID
#Weakness
*Symptomatic
#Confusion
**[[Calcium gluconate]]/[[calcium chloride|chloride]] 10mL of 10% soln IV over 10min
#Sz
*Correct [[hypomag]] at same time (otherwise PTH is inhibited)
#Chvostek's/Trouseau's
*Avoid phenothiazine [[antipsychotics]] (may precipitate extrapyramidal symptoms)
#ECG
*Avoid [[furosemide]] (may worsen hypocalcemia)
##QT prolongation


==DDX==
==Disposition==
#Shock
*Admit all symptomatic patients
#sepsis
#renal failure
#cimetidine
#hypoparathyroid
#inc phos
#vit D def
#fat embolism
#strychnine
#hypomag
#tetanus


==Treatment==
==See Also==
#Asymptomatic
*[[Electrolyte Abnormalities (Main)]]
##calcium gluconate 1 gm PO Q6hrs
##vitamin D (calcitriol) 0.2 mcg BID
#Symptomatic
##calcium gluconate/chloride 10mL of 10% sol over 10min IV


==Source ==
==References==
2/12/06 DONALDSON (adapted from Tintinalli)
<references/>


[[Category:FEN]]
[[Category:FEN]]

Revisión actual - 20:16 17 abr 2024

Background

Serum Levels

Normal value ranges may vary slightly among different laboratories

  • Low: <8.9 mg/dL[1] (Ionized: <4.8 mg/dL or <1.20 millimol/L[2])
  • Critical low: <6.6 mg/dL[3] (Ionized: <3.5 mg/dL[4])


  • Correct for hypoalbumimia
    • Corrected Ca = (0.8 *(Normal Alb - Patient's Alb)) + Serum Ca

Fraction[5]

  • 15% bound to anions (phosphate, lactate, citrate)
  • 40% bound to albumin
  • 45% free (regulated by PTH, Vit-D)

Causes

Clinical Features

Symptoms of hypocalcemia

Differential Diagnosis

Movement Disorders and Other Abnormal Contractions

Jaw Spasms

Evaluation

ECG

Hypocalcemia with QTc prolongation
  • QT Prolongation via increasing the ST length
    • Only hypothermia and hypocalcemia prolong QT this way

Trousseau's sign

Spasm associated with symptomatic hypocalcemia
  • Inflate BP cuff for 2-3 minutes
  • Positive = Muscle contractions of the hand and wrist
  • Specificity 99%, sensitivity 94%

Chvostek sign

  • Tapping on the face just anterior to the ear and just below the zygomatic bone
  • Positive = Ipsilateral facial twitching
  • Specificity 96%, sensitivity 26%

Labs

  • BMP
  • Mag, Phos
  • PTH (secondary hyperparathyroidism)

Management

Avoid empiric treatment in patients taking digoxin due to risk for Stone Heart

Disposition

  • Admit all symptomatic patients

See Also

References

  1. ↑ Harbor-UCLA computer system accessed 08/15/2019
  2. ↑ https://www.ucsfhealth.org/tests/003486.html
  3. ↑ Harbor-UCLA computer system accessed 08/15/2019
  4. ↑ http://www.clinlabnavigator.com/calcium-ionized.html
  5. ↑ Yu, AS. Relation between total and ionized serum calcium concentrations. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on October 6th, 2016.)
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