Hypocalcemia

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Presentation :

• Mild: perioral numbness, paresthesias of the hands and feet, muscle cramps (Chvostek + Trousseau sign; see below)
• Severe: carpopedal spasm, laryngospasm, and focal or generalized seizures

Pathophysiology :

• Etiologies include
  • Hypoparathyroidism
  • Vitamin D Deficiency
  • Chronic Kidney Disease
  • hungry bone syndrome
  • Osteoblastic metastases (prostate cancer, breast cancer)
  • Antiresorptive drugs, such as intravenous bisphosphonates and denosumab
    • Therefore, it is important to assess vitamin D levels and correct deficiency before beginning treatment with an antiresorptive drug.

Diagnostic Testing:

• EKG to assess for QTc prolongation
• If low albumin or concurrent acid/base disorder, consider verifying with ionized Ca measurement
• Check Mg level
• Trousseau's sign: induction of carpal spasm by inflation of a sphygmomanometer above systolic blood pressure for three minutes
  
• Chvostek's sign: contraction of the ipsilateral facial muscles elicited by tapping the facial nerve just anterior to the ear
  

Treatment :

• Severe hypocalcemia (<7.5 mg/dL; prolonged QT interval; symptoms)
  • Telemetry
  • IV calcium gluconate
• Mild hypocalcemia:
  • Vitamin D supplementation, 1000-4000 IU/day AND Calcium carbonate/citrate PO 1-3 g/day in divided doses taken with meals
• Must correct coexisting hypomagnesemia!
• Teriparatide, 20 μg twice daily, rapidly eliminates symptoms of hypocalcemia in acute postsurgical hypoparathyroidism

Prognosis:

References: