Hypocalcemia
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Clinical features
Hypocalcemia is often mistaken as neurological disorder. It is characterized by cramps and tetany. Laryngospasm with stridor can obstruct the airway. Convulsions, perioral and peripheral paresthesias and abdominal pain can develop.Classic physical findings include Chvostek sign (Contraction of the facial muscle in response to tapping the facial nerve ) and Trousseau sign ( carpal spasm occurring with occlusion of the brachial artery by a blood pressure cuff ).
Investigations
Serum calcium level. lonized calcium level, serum electrolytes, serum magnesium level, PTH level, serum albumin and ECG
Diagnosis
Total calcium level less then 8mg / dL and ionized calcium level less than 4.6mg / dL . Serum magnesium concentration is also low and ECG shows QT prolongation
Management: Severe symptomatic hypocalcemia
- Inj Calcium gluconate 10-15mg / Kg added in 1L of 5 % dextrose water is infused over 4-6 hours . By monitoring serum calcium level frequently ( every 4-6 hours ) , the infusion rate is adjusted to maintain the calcium level at 7-8.5 mg / dL
- If there is no improvement then give magnesium sulfate
- Inj- magnesium sulfate 1-2gm diluted in 1L of dextrose 5 % N / saline 0.9 %
Asymptomatic hypocalcemia
- Tab- Calcium + Cholecalciferol (Qalsan - D), 1 tab PO x OD (if their vitamin - D deficiency)
- The low serum calcium associated with hypoalbunemia does not require replacement therapy
- If serum magnesium is low, therapy must include magnesium replacements, which by itself usually correct hypocalcemia.s