Diferencia entre revisiones de «Hypocalcemia»
(Text replacement - "Pt's" to "Patient's") |
(Text replacement - "* " to "*") |
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| Línea 4: | Línea 4: | ||
*Correct for hypoalbumimia | *Correct for hypoalbumimia | ||
**Corrected Ca = (0.8 * (Normal Alb - Patient's Alb)) + Serum Ca | **Corrected Ca = (0.8 *(Normal Alb - Patient's Alb)) + Serum Ca | ||
===Causes=== | ===Causes=== | ||
| Línea 64: | Línea 64: | ||
==Disposition== | ==Disposition== | ||
* Admit all symptomatic patients | *Admit all symptomatic patients | ||
==See Also== | ==See Also== | ||
Revisión del 13:51 6 jul 2016
Background
- Low <8.5 (<2.0 ionized)
- Low! <6.5 (<1.5 ionized)
- Correct for hypoalbumimia
- Corrected Ca = (0.8 *(Normal Alb - Patient's Alb)) + Serum Ca
Causes
- Misc
- Shock
- Sepsis
- Pancreatitis
- Hypomag
- Rhabdo (phosphate overload)
- Massive transfusion
- Systemic Hydrofluoric Acid toxicity
- DiGeorge syndrome
- Decreased absorption
- Vit D deficiency
- Increased excretion
- Endocrine
- Drugs
Clinical Features
- Paresthesias (mouth, fingertips)
- ↑ DTRs
- Cramps
- Weakness
- Confusion
- Seizures
- Chvostek/Trousseau signs, Tetany
- Hallucinations
Differential Diagnosis
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
Diagnosis
- Trousseau's Sign (Mod to high SN and SP)
- Inflate BP cuff for 2-3 mins
- Positive = Muscle contractions of the hand and wrist
- Chvostek's Sign (Low SN and SP)
- Tapping on the face just anterior to the ear and just below the zygomatic bone
- Positive = Ipsilateral facial twitching
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)
Disposition
- Admit all symptomatic patients
See Also
References
Video
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