What is Hypocalcemia?

The absence of enough calcium in blood is known as Hypocalcemia. In this case the level of serum calcium in blood is less than 2.1 mmol/L or its 9mg/dl. In case of ionized calcium, the level is less than 1.1 mmol/L. A fully grown man can have over one kilogram of calcium in his body. About 99% of total calcium in the body stored in the bones and only 1% works for the other body parts; such as blood. About half of the total calcium is stayed in ionized form. Among the rest 50%, about 40% is bound with protein and the rest 10% is bounded to anions.

In case of Hypocalcemia, unusual protein level in blood, the rate of plasma calcium gets irregular. In blood, calcium bounds with proteins like serum albumin which is measured for determining the Hypocalcemia. However, the patients with chronic diseases or hepatic disease may show low level of albumin which may lead to wrong calculation. For this reason, the counting of ionized calcium gives more accurate result.

Hypocalcemia is very common to see among the patients who are hospitalized for a long time. Depending on the severity and longevity, the Hypocalcemia can be life threatening.

Hypocalcemia symptoms

Because of its long term nature, the Hypocalcemia shows its symptoms much later. The starting signs of Hypocalcemia are the following:

• Numbness and perioral tingling as well as paraesthesia; which means needles and pins sensation on the extremities of the feet and fingers. These are the first symptoms of Hypocalcemia that most patients show.
• Petechia starts as local one off spots which later start to grow as rashes.
• Wheezing that may come from bronchospasm.
• Dyspagia.
• In some cases, change of voice.
• Tetany, or in other words, muscle cramps which are most common in the back and lower edge. This may turn into carpopedal spasm.

In later stage of Tetany, Trousseau sign is showed up. This is caused by eliciting carpal spasm if the blood pressure increases. The Chvostek’s sign may also come up.

The neurologic symptoms of Hypocalcemia are:

• Depression.
• Irritability.
• Personality change.
• Fatigue.
• Seizure.
• Losing control over movement.

The physical Hypocalcemia sings include:

• Coarse hair.
• Brittle nail.
• Dry skin.
• Shortness of breath.
• Psoriasis.

In the severe condition of Hypocalcemia, the patient may have these two complications:

• Laryngospasm.
• Cardiac arrhythmias.

The ECG changes in Hypocalcemia are:

• Prolonged QTc
• Prolonged ST interval

Hypocalcemia causes

The causes of Hypocalcemia are very wide. The main reasons for this disease are deficiency of parathyroid hormone or PTH, deficiency of Vitamin D. Also low level of magnesium or hypomagnesaemia and high level of magnesium or hypomagnesaemia can cause Hypocalcemia. It has a close relation with low PTH level as well as high PTH level as at the higher level, the parathyroid hormone does not work. In case of chronic renal failure, the Vitamin D is not efficient as the calcium level falls. The Hypocalcemia may happen for these reasons:

• Irregular eating.
• Over diet on magnesium based foods.
• Prolonged medication.

In case of low PTH:

• Hereditary hypoparathyroidism.
• Acquired hypoparathyroidism.

Nonworking PTH:

• Decrease dietary intake.
• Defective Vitamin D metabolism.
• Chronic renal failure.
• Intestinal malabsorption.
• Pseudohypoparathyroidism.

Deficient PTH:

• Tumour lysis syndrome.
• Rhabdomyolysis.

Other causes include:

• Exposure to the hydrofluoric acid.
• Complication from Hypocalcemia pancreatitis.
• Hyperventilation.
• Alkalosis.
• Chelation therapy.
• Very low birth weight.
• Gestational age less than 32 weeks.

Hypocalcemia treatment

The treatment of Hypocalcemia varies over the cause, symptoms, longevity and severity.

Medical care

Acute Hypocalcemia – Calcium salts are used instantly for sever Hypocalcemia with cardiac arrhythmias or Tetany when fast correction is required. Calcium gluconate and calcium chloride are used in correct amount with proper administration.

Continuous ECG monitoring is required for the patients with cardiac arrhythmias.

Chronic Hypocalcemia – In case of PTH deficiency, oral calcium supplements are used. In some serious case, Vitamin D is used. But as the PTH deficiency can convert Vitamin D into calcitriol, it may not work some times. For this, the best option is to sue alpha hydroxyvitamin D3. If the patient is on dialysis, oral treatment is not appropriate. Instead, the calcium can be given between meals. Also, increasing the amount of calcium in the dialysate bath is a good option.

Diet

Increasing calcium over 1 g/d in the diet is important for the Hypocalcemia patients. This works better for the chronic Hypocalcemia patients if they have Vitamin D deficiency.

Medication

For the Hypocalcemia patients, calcium chloride, calcium gluconate or Kalcinate and calcium carbonate are used. The calcium chloride is given if the patient has serious condition, like cardiac arrest. Calcium gluconate works better for muscle cramps or nerve weakness. The calcium carbonate is used in initial stage of Hypocalcemia.

Vitamin D, such as calcitriol is frequently used for the patients with Vitamin D deficiency.

Neonatal Hypocalcemia

In neonates, it is very common to see children with Hypocalcemia. It usually occurs in two forms: early neonatal Hypocalcemia (within three days from the birth) and late neonatal Hypocalcemia (three to seven days after the birth). The mortality rate is higher in children with neonatal Hypocalcemia in pediatric ICU than children with normal calcium level.

Hypocalcemia in Children

Hypocalcemia is common among the children and about one third child with low birth weight gets Hypocalcemia. The minimum weight is less than one and half kg. Also about 90% of babies whose gestational age is less than 32 weeks at birth face Hypocalcemia. If the mother has diabetes, the child has more tendency of getting Hypocalcemia.

Hypocalcemia and Tetany

Hypocalcemia has a close relation with Tetany. Tetany is one of the symptoms of Hypocalcemia where the patient feels contradiction of muscles. Because of low calcium level in blood, the permeability of neuronal membranes increases to sodium ions; causing narrowing of peripheral skeletal muscles. The low level of calcium is the Hypocalcemia.

Hypocalcemia in Dogs

Dog as well as several other animals can have Hypocalcemia. This is happen because of calcium demand over a long time. In many animals, the intestinal absorption does not work efficiently and for that respond to calcium become slower. The dog face muscle spasms and if it is not treated fast, it may die. For treating Hypocalcemia in animals, an injection of calcium gluconate is applied.

Also Read:

• Calcium Supplements Lead To Heart Attack
• Vitamin D Deficiency Symptoms
• Top Six health risks of low vitamin D

by admin on 04. Sep, 2010 in Diseases and Conditions