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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.