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Sunday, February 1, 2015

Hypocalcemia: Causes, Symptoms, and Treatment

Calcium, hypocalcemia, decreased calcium, nursing school, nursing students, osteoporosis, hypoparathyroidism

Overview


Normal levels of serum calcium range from 8.9 to 10.3 mg/dL. Give or take, institutions will vary. Hypocalcemia is when we are low on calcium. The patient's serum level is below 8.9 mg/dL. Hypocalcemia is a big deal because it can potentiate arrhythmias and seizures. 

Side note: that whole "I before E" is a load of bull.
Parathyroid Hormone (PTH) is important to maintain normal levels of calcium. In a nutshell, it transfers calcium from bone to blood plasma.

Causes


  • Hypoparathyroidism- calcium shifts from bloodstream into the bone due to ischemia and/or trauma to the parathyroid.
  • Acute Pancreatitis- Hypocalcemia during pancreatisis is associated with a poor outcome. The cause is not yet understood. There is an 85% occurrence of hypocalcemia in acute, severe pancreatitis.
  • Magnesium Imbalances- Severe hypomagnesemia (I'm glad I'm not speaking out loud.) inhibits the secretion of PTH, so calcium levels will drop. This is important because you'll need to correct the magnesium levels to correct the calcium imbalance.
  • Hyperphsophatemia- Phosphates bind to calcium in the bloodstream. Be careful when giving hypertonic sodium phosphate enemas.
  • Alkalosis- A greater amount of calcium binds to plasma proteins so there's less calcium available.
  • Low Vitamin D- Vitamin D must be present for calcium to be absorbed. Make sure supplements for Osteoporosis have Vitamin D.
There are more causes but for our purposes, that covers most of it. Basically, the takeaway is that low levels of calcium aren't usually due to low levels of intake but are because of another underlying issue.

Symptoms / Clinical Manifestations


  • Numbness/Tingling- in fingers, toes, around the mouth
  • Muscle Cramps/Spasms
  • Hyperactive Deep-Tendon Reflexes
  • Trousseau's Sign- Be aware for false positives
  • Chvostek's Sign- Be aware for false positives
  • Convulsions- Severe hypocalcemia
  • Decreased Contractility- leads to low cardiac output
  • Prolonged QT Interval
  • Arrhythmias- V Tach to brady, to asystole
  • Depression, Anxiety, Irritability
The degree to which any of these symptoms show up will be dependent upon the degree of severity of the hypocalcemia. I only included Trousseau's and Chvostek's sign because these are fast and easy to do. They are also cheap. However, they are NOT specific, so just keep that in mind.

Treatment


Treatment, like most everything else, will depend on the cause or severity of the case. Like I said earlier if hypocalcemia is because of hypomagnesemia then you also need to address the deficiency in magnesium. Give some mag. Give some calcium.
  • IV Calcium Replacement- used in emergency situations. It is irritating to the vein so it should be administered through a central line. Be VERY cautious in patients receiving Digitalis.
  • Oral Calcium Replacement- Preferred route. It is much safer than IV.  Calcium Carbonate is the least expensive so you'll see this the most often.

BONUS


Osteoporosis is big issue, especially for post-menopausal women. This happens because the decrease in estrogen decreases calcium absorption, The best way to treat Osteoporosis (or just about anything) is through PREVENTION!! 

Ahh. Prevention. My first degree. Sadly, most people don't take it near as seriously as they should. Thus, why I had issues finding jobs, and have went the nursing route.

If you're reading this, you're probably no longer a teenager. Those were the years we should've been chugging milk and eating yogurt like mad. You're probably in the age group of 20-30. You're probably a female. You need to get your booty in the gym and lift some weights. You won't get big or huge like a man because you lack the testosterone needed to build those muscles. What you will get are nice, dense bones.

Yeah, baby. Check out them bones. Those are some nice bones.....



Ok. Ok. Quit while you're ahead, Nightingale.

Other posts you might want to check:

Hypernatremia at a Glance

What are some ways you remember the signs and symptoms of electrolyte imbalances?

Would anyone be interested in a post about lifting weights??
Leave a comment below or email me at nurse.nightingale13@gmail.com

7 comments:

  1. Great article! Worth reading :)
    I think the article below will complement your article:
    http://healthcommkey.org/habits-to-prevent-osteoporosis/

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    1. That is a good article! I totally forgot about the role that caffeine plays in our body's absorption of calcium. Thanks for sharing! :)

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  2. Wish they'd warned me to check parathyroid levels after they removed my thyroid. Now I must get Forteo shots daily (@$85.00) for the rest of my life. At least I'm alive...thanks to a sharp ER doctor who started IV calcium immediately. My trembling is getting better and Im perking up. Thanks for the great post. Maybe people will watch those calcium levels.

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    1. Aw, good luck managing your health after having your thyroid removed. Good thing that ER doc knew to replace your calcium. Thanks for reading and sharing your story! :)

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  3. When a doctor has to diagnose thyroidism in patients so he just have to check the TH values in patients and if the values are not normal so he advises the medication accordingly but I would also suggest them Physiotherapy North Ryde to have relief of pains in joints due to hypocalcemia as a lot people are now becoming the effectees of the problem.

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