Hypocalcemia¶
Trey Richardson
Background¶
-
Can be divided into low parathyroid hormone and high parathyroid hormone states
-
Low PTH
-
Magnesium deficiency
-
Post-operative for parathyroidectomy
-
DiGeorge syndrome
-
Medications: Bisphosphonates, denosumab, aminoglycosides, gadolinium
-
Acidemia (Serum Ca is inversely proportional to pH)
-
Infiltrative disease: sarcoid, hemochromatosis, malignancies
-
Autoimmune hypoparathyroidism
-
CRRT (if using regional citrate anticoagulation)
-
-
High PTH
-
Late-stage CKD
-
Hyperphosphatemia
-
Vitamin D deficiency
-
Pseudohypoparathyroidism/Parathyroid resistance
-
Consumption/deposition: Pancreatitis, rhabdomyolysis, some osteoblastic metastases
-
Sepsis or critical illness
-
Presentation¶
-
Chvostek and Trousseau’s signs, laryngospasm, seizures, widened QRS and arrhythmias
-
Hemodynamic instability
Evaluation¶
-
Check PTH, albumin, iCal, VBG, Vitamin D
-
Review medications for possible offenders
Management¶
-
Under most circumstances there is no need to replace calcium. Instead, focus on correcting the underlying perturbation (e.g. acidemia, hypomagnesemia, treating pancreatitis, etc. )
-
If hemodynamic instability, cardiac electrical instability, seizures then aggressive intravenous replacement is warranted.
-
Also consider preemptive repletion for patients requiring high-volume of blood transfusions (citrate in blood products can cause hypocalcemia)
-
1 g of CaCl is equivalent to 3 grams of Ca Gluconate
-
-
Avoid treatment in hyperphosphatemia, advanced CKD/ESRD, and rhabdomyolysis