Hypocalcaemia

Data gathering

  • Signs and symptoms
    • Peri-oral and/or digital paraesthesia
    • Spasms of hands, feet
    • Laryngospasms, seizures
    • Facial spasm after tapping facial nerve (Chvostek’s sign)
  • Causes
    • Low magnesium
    • Vitamin D deficiency
    • Medications – PPIs, Furosemide, Anticonvulsants, Bisphosphonates, Calcitonin, Cinacalcet
    • Hungry bone syndrome
    • High phosphate intake
    • Acute pancreatitis
    • Early rhabdomylosis
    • Hypoparathyroidism
    • Pseudohypoparathyroidism

 

Clinical management

  • < 1.8 mmol/L or symptomatic
    • If symptomatic – admit to A+E
    • If not acutely unwell – discuss with medical team for urgent repeat calcium
  • 1.8 – 2.19 mmol/L and asymptomatic
    • Bloods – Repeat Ca, Bone profile, Magnesium, U+E, LFTs, vitamin D, PTH
      • Low magnesium/Vitamin D – correction is necessary to correct calcium
      • PTH raised, other bloods normal – possible borderline vitamin D deficiency, medications, early rhabdomyolysis, pseudohypoparathyroidism
      • PTH low/normal, other bloods normal – consider medications, hungry bone syndrome, hypoparathyroidism