Diferencia entre revisiones de «Hypocalcemia»
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==Background== | ==Background== | ||
===Serum Levels=== | |||
''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 - 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) | |||
2/ | ==Management== | ||
''Avoid empiric treatment in patients taking [[digoxin]] due to risk for [[Stone Heart]]'' | |||
*Asymptomatic | |||
**[[Calcium gluconate]] 1 gm PO Q6hrs | |||
**Vitamin D (calcitriol) 0.2 mcg BID | |||
*Symptomatic | |||
**[[Calcium gluconate]]/[[calcium chloride|chloride]] 10mL of 10% soln IV over 10min | |||
*Correct [[hypomag]] at same time (otherwise PTH is inhibited) | |||
*Avoid phenothiazine [[antipsychotics]] (may precipitate extrapyramidal symptoms) | |||
*Avoid [[furosemide]] (may worsen hypocalcemia) | |||
==Disposition== | |||
*Admit all symptomatic patients | |||
==See Also== | |||
*[[Electrolyte Abnormalities (Main)]] | |||
==References== | |||
<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
- Misc
- Shock
- Sepsis
- Pancreatitis
- Hypomag
- Rhabdo (phosphate overload)
- Massive transfusion
- Systemic Hydrofluoric Acid toxicity
- DiGeorge syndrome
- Decreased absorption
- Increased excretion
- Endocrine
- Drugs
- Cimetidine
- Phenytoin
- Lasix, loop diuretics
- Norepinephrine
- Glucagon
- Glucocorticoids
- Magnesium sulfate
- Nitroprusside
Clinical Features
Symptoms of hypocalcemia
- Paresthesias (mouth, fingertips)
- ↑ DTRs
- Cramps
- Weakness
- Confusion
- Seizures
- Chvostek/Trousseau signs, Tetany
- Hallucinations
- Laryngospasm
- Bronchospasm
- Cardiac dysrhythmias
Differential Diagnosis
Movement Disorders and Other Abnormal Contractions
- Chorea
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Hypocalcemia
- Strychnine toxicity
- Acute tetanus
- Parkinson's disease
- Mono amine oxidase inhibitor toxicity
- Phencyclidine toxicity
- Anti-NMDA receptor encephalitis
- Huntington disease
- Wilson's disease
- CVA
- Schizophrenia
- Psychotic agitation
- Dementia
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
- Dystonic reaction
- Extrapyramidal reaction
- Torticollis
- Idiopathic movement disorder
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Evaluation
ECG
- QT Prolongation via increasing the ST length
- Only hypothermia and hypocalcemia prolong QT this way
Trousseau's sign
- 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
- Asymptomatic
- Calcium gluconate 1 gm PO Q6hrs
- Vitamin D (calcitriol) 0.2 mcg BID
- Symptomatic
- Calcium gluconate/chloride 10mL of 10% soln IV over 10min
- Correct hypomag at same time (otherwise PTH is inhibited)
- Avoid phenothiazine antipsychotics (may precipitate extrapyramidal symptoms)
- Avoid furosemide (may worsen hypocalcemia)
Disposition
- Admit all symptomatic patients
See Also
References
- ↑ Harbor-UCLA computer system accessed 08/15/2019
- ↑ https://www.ucsfhealth.org/tests/003486.html
- ↑ Harbor-UCLA computer system accessed 08/15/2019
- ↑ http://www.clinlabnavigator.com/calcium-ionized.html
- ↑ Yu, AS. Relation between total and ionized serum calcium concentrations. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on October 6th, 2016.)