- 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.