II. Causes
- Most common causes
- Hypoalbuminemia
- Vitamin D Deficiency
- Miscellaneous and Multifactorial causes
- Hypoalbuminemia
- Use Corrected Serum Calcium for albumin or Ionized Calcium to interpret Calcium level
- Gram-Negative Sepsis (Marker for increased Sepsis related mortality)
- Hypoalbuminemia
- Low Parathyroid Hormone (or normal Parathyroid Hormone level)
- Hypomagnesemia
- Hypoparathyroidism
- Urine Calcium to Creatinine Ratio decreased
- Serum Phosphorus increased
- Calcium-sensing receptor activating mutation
- Serum Phosphorus increased
- Urine Calcium to Creatinine Ratio increased
- High Parathyroid Hormone (secondary Hyperparathyroidism as a reflex response to Hypocalcemia)
- Low Serum Phosphate
- See Medication-Induced Hypocalcemia
- Pancreatitis
- Vitamin D Deficiency
- Decreased 25-hydroxyvitamin D
- High or normal Serum Phosphate
- Rhabdomyolysis
- Tumor lysis
- Acute Renal Failure or Chronic Kidney Disease
- Decreased 1,25-dihydroxyvitamin D
- See Renal Osteodystrophy
- Pseudohypoparathyroidism (genetic PTH resistance)
- Associated with adequate PTH levels, but a PTH receptor defect
- Associated with a shortened fourth digits on the hands and feet
- Low Serum Phosphate
III. Symptoms
- Cardiovascular (Systolic Dysfunction)
- Neurologic
- Headache
- Muscular Fasciculations, Muscle cramping, Muscle spasms, Muscle stiffness
- Seizures
- Paresthesias
- Circumoral numbness
- Nervousness
- Weakness
- Decreased Vision
- Chronic Hypocalcemia may demonstrate Parkinsonism, Dementia
- Gastrointestinal
- Psychiatric
- Anxiety
- Depressed Mood
IV. Signs
- Cardiovascular
- Respiratory
- Neurologic
- Skin
- Hair Loss (due to dry, brittle hair)
- Dry, puffy skin
- Eyes
- Premature Cataracts
- Papilledema
V. Diagnostics: Electrocardiogram (EKG)
- Prolonged QTc with severe Hypocalcemia (may degenerate into Torsades de Pointes)
VI. Labs
-
Serum Calcium low
- Total Corrected Serum Calcium (for Serum Albumin) or
- Ionized Calcium
- Serum Electrolytes
- Parathyroid Hormone (PTH)
-
Vitamin D
- 25-Hydroxyvitamin D
- 1,25-Dihydroxyvitamin D
- Urine Calcium to Creatinine Ratio (24 hour Urine Calcium and Urine Creatinine)
VII. Evaluation
- Confirm Hypocalcemia
- Obtain Corrected Serum Calcium (for Serum Albumin) or Ionized Calcium
- Correct Serum Calcium 0.8 mg/dl for every 1 gram Serum Albumin is below normal range
- Obtain labs to narrow causes (see labs above)
- Parathyroid Hormone
- Serum Electrolytes (Serum Phosphate, Serum Magnesium, Serum Creatinine)
- Vitamin D (25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D)
- Initial correction of abnormalities (if indicated)
- Treat severe, symptomatic Hypocalcemia (See Calcium Replacement)
- Correct Serum Magnesium if abnormal
- Parathyroid Hormone (PTH) Low or Normal
-
Parathyroid Hormone (PTH) High
- Serum Creatinine increased
- Evaluate for Chronic Kidney Disease
- Manage as Renal Osteodystrophy
- Serum Creatinine normal
- Serum Phosphorus high
- Pseudohypoparathyroidism (genetic PTH resistance)
- Serum Phosphorus normal or low
- Treat as Vitamin D Deficiency if low 25-Hydroxyvitamin D
- Serum Phosphorus high
- Serum Creatinine increased
VIII. Management
- See Calcium Replacement
- Consider replacement if Corrected Serum Calcium <10 mg/dl
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Reduction of the blood calcium below normal. Manifestations include hyperactive deep tendon reflexes, Chvostek's sign, muscle and abdominal cramps, and carpopedal spasm. (Dorland, 27th ed) |
| Definition (CSP) | reduction of the blood calcium below normal; manifestations include hyperactive deep tendon reflexes, muscle and abdominal cramps, and carpopedal spasm. |
| Concepts | Pathologic Function (T046) |
| MSH | D006996 |
| ICD9 | 275.41 |
| ICD10 | E83.51 |
| SnomedCT | 154752005, 267505006, 5291005 |
| English | Hypocalcemias, CALCIUM BLOOD DECREASED, HYPOCALCAEMIA, HYPOCALCEMIA, hypocalcemia, hypocalcemia (diagnosis), Hypocalcemia, Hypocalcemia [Disease/Finding], abnormally low blood calcium levels, Calcium deficiency disease, Hypocalcemia syndrome, Hypocalcaemia, Hypocalcaemia syndrome, Hypocalcemia (disorder), hypocalcaemia |
| French | HYPOCALCEMIE, DIMINUTION DE LA CALCEMIE, Hypocalcémie |
| Portuguese | HIPOCALCEMIA, DIMINUICAO DA CALCEMIA, Hipocalcemia |
| Spanish | HIPOCALCEMIA, CALCEMIA DISMINUIDAD, enfermedad por deficiencia de calcio, hipocalcemia (trastorno), hipocalcemia, síndrome de hipocalcemia, síndrome hipocalcémico, Hipocalcemia |
| German | HYPOKALZAEMIE, KALZIUMBLUTSPIEGEL VERMINDERT, Hypokalzaemie, Hypocalcaemia, Hypokalzämie |
| Japanese | 低カルシウム血症, ﾃｲｶﾙｼｳﾑｹﾂｼｮｳ, ﾃｲｶﾙｼｳﾑｹｯｼｮｳ |
| Swedish | Hypokalcemi |
| Czech | hypokalcémie, Hypokalcemie |
| Finnish | Hypokalsemia |
| Russian | GIPOKAL'TSIEMIIA, ГИПОКАЛЬЦИЕМИЯ |
| Polish | Hipokalcemia |
| Hungarian | Hypocalcaemia |
| Norwegian | Hypokalsemi |
| Dutch | hypocalciëmie, Calciëmie, hypo-, Hypocalciëmie |
| Italian | Ipocalcemia |
Ontology: Serum calcium decreased (C0595882)
| Concepts | Finding (T033) |
| English | Calcium Serum Decreased, Calcium serum decreased, Serum calcium decreased |
| Dutch | calcium serum verlaagd, serum calcium verlaagd |
| French | Calcium sérique diminué |
| German | Kalzium im Serum erniedrigt |
| Italian | Calcio sierico diminuito |
| Portuguese | Cálcio do soro diminuído, Cálcio sérico diminuído |
| Spanish | Calcio disminuido en suero |
| Japanese | 血清カルシウム減少, ｹｯｾｲｶﾙｼｳﾑｹﾞﾝｼｮｳ |
| Czech | Snížené kalcium v séru |
| Hungarian | Kalcium szérumszint csökkent, Szérum kalcium csökkent |
