# Hypocalcemia --- **Hypocalcemia** is a condition where is a dangerously low level of [[calcium]] in the blood. As we have a very efficient reservoir of calcium in our bones, this is not usually due to a lack of dietary calcium. Because calcium helps muscle contractions and nerve impulses, symptoms of hypocalcemia include muscles spasms and convulsions. Acute hypocalcemia can be life threatening, mainly due to how it affects cardiac function. ## Causes Hypocalcemia is typically secondary to a metabolic condition, most often [[renal failure]]. Renal failure causes a lot of electrolyte levels to rise, and significantly [[phosphate]] levels to rise, which tanks calcium levels. - [[hypoparathyroidism]] - malabsorption conditions - [[celiac disease]] - Chron's - [[alcohol use disorder]] - malabsorption of [[vitamin D]] - Vitamin D helps the absorption of dietary calcium/activation of PTH - [[pancreatitis]] - the exact reason is not very clearn, but it's a common side effect. - calcium gets bound up in the fatty acids? Or something - maybe it's the [[catecholamines]] shift the calcium around - [[kidneys|kidney injury]] - transfusion of citrated blood - many different medications, some include: - antacids - caffeine - PPIs ## Signs & Symptoms The signs and symptoms of hypocalcemia pretty much all have to do with the disruption to a cell's [[membrane potential]], causing spasms, and other excitible-type reactions. - cardiac irritability/arrythmias like [[ventricular tachycardia|vtac]] - **Trousseau sign** (present in most people with hypocalcemia) - A facial twitch when the [[facial nerve]] is tapped - **Chvostek sign** (not as definitive, as it can be present in other conditions) - A carpel spasm with reduced blood supply to the hand (usually by a BP cuff or torniquet) - [[seizures]] - dyspnea/laryngospasm - abnormal [[coagulation|clotting]] - tetany - circumoral numbness - paresthesia - anxiety - brittle bones/nails ## Diagnostic Tests A variety of labs can be drawn to check for hypocalcemia - both serum and ionized Ca - albumin, Mg and PO4 - which calcium binds too ## Treatment Treatment for hypocalcemia largely involves treating the underlying cause and reversing the process/replacing the calcium. For example: - IV infusions of Ca salt in emergent situations - Calcium gluconate 4-5 mEq (less irritating) - Calcium chloride, 13.6 mEq (more irritating, can damage tissue) - Antacids - salmon, leafy greens, tofu Oral Ca and vitamin D supplements Ca rich Diet ## Nursing Considerations Monitor • Postural hypotension (keep in bed, monitor BP) • Airway (laryngospasm) Seizure precautions Educate • Vitamin D • Increase PO intake, supplements (no more than 500mg) • Avoid overuse of laxatives & antacids (PO4) ___