Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Management of Hypocalcemia

- Discussion:
    - physical properties
    - state in body fluids
    - physiologic roles of calcium are well established;
    - abnormally low concentrations of Ca permit spontaneous discharges of both sensory & motor fibers in peripheral nerves, leading to tetany;
           - w/ elevated levels, nerve impulses are blocked, leading to coma;
    - calcium is also necessary & important addition to cell membranes, giving strength to these structures and regulating permeability;
    - sudden death may occur when the ionized calcium falls below 2 mg/dL;
    - differential diagnosis

- Lab Values:
    - normal values: 8.50 - 10.50 mg/dl or 4.48 -  5.21 mg/dl (ionized);
    - ionized calcium level below 3 mg/dL indicates need for supplemental calcium, even if there are no clinical symptoms;

- Evaluation:
    - note if patient is symptomatic;
    - hypocalcemic pts who are not symptomatic do not require urgent correction with IV Ca;
    - history of worsening paresthesias in her arms and legs and/or history of cramps in hands and facial muscles;
    - physical examination revealed mild hyperreflexia;
    - diarrhea is also sometimes seen;
    - Chvostek's sign:
         - facial muscle spasm elicited by tapring facial nerve immediately anterior to the earlobe and below the zygomatic arch;
    - Trousseau's sign:
         - carpal spasm elicited by occluding arterial blood flow to forearm for 3-5 minutes;
    - check albumin: Ca decrease 0.8 for ea 1 gm/dl decr of albumin;
    - dangerous meds:
          - digoxin;
                - calcium will potentiate the action of digoxin;
                - consider continuous EKG, if pt requires IV Ca;
    - EKG Changes

- Treatment: (calcium supplements)
    - if serum phosphate concentration is elevated in severe hypocalcemia, correction of hyperphosphatemia must be carried out w/ IV glucose & insulin before calcium is given inorder to avoid metastatic calcification;
    - severe symptomatic hypocalcemia:
           - requires immediate treatment because of the danger of respiratory failure due to laryngospasm;
           - if patient's PO4 is normal or low, then:
           - Ca Gluconate 10-20ml (1-2gm) of 10% solution IV  in 100ml of D5W over 5 to 30 min

Serum and other calcium fractions in patients after severe musculoskeletal trauma.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 4, 2012 3:36 pm

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