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ALL / Endocrinology
Hypocalcaemia: causes and management
Hypocalcaemia: causes and management
The clinical history combined with parathyroid hormone levels will reveal the cause of hypocalcaemia in the majority of casesCauses
- vitamin D deficiency (osteomalacia)
- chronic kidney disease
- hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
- pseudohypoparathyroidism (target cells insensitive to PTH)
- rhabdomyolysis (initial stages)
- magnesium deficiency (due to end organ PTH resistance)
- massive blood transfusion
- acute pancreatitis
Contamination of blood samples with EDTA may also give falsely low calcium levels.
Management
- severe hypocalcaemia (e.g. carpopedal spasm, tetany, seizures or prolonged QT interval) requires IV calcium replacement
- the preferred method is with intravenous calcium gluconate, 10ml of 10% solution over 10 minutes
- intravenous calcium chloride is more likely to cause local irritation
- ECG monitoring is recommended
- coexistent hypomagnesaemia should be corrected, as it impairs PTH secretion and action and may make hypocalcaemia refractory; in severe or symptomatic hypocalcaemia, IV calcium should not be delayed and magnesium should be replaced concurrently
- further management depends on the underlying cause
+PassMedicine Notes
The clinical history combined with parathyroid hormone levels will reveal the cause of hypocalcaemia in the majority of cases
Causes- vitamin D deficiency (osteomalacia)
- chronic kidney disease
- hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
- pseudohypoparathyroidism (target cells insensitive to PTH)
- rhabdomyolysis (initial stages)
- magnesium deficiency (due to end organ PTH resistance)
- massive blood transfusion
- acute pancreatitis
Contamination of blood samples with EDTA may also give falsely low calcium levels.
Management- severe hypocalcaemia (e.g. carpopedal spasm, tetany, seizures or prolonged QT interval) requires IV calcium replacement
- the preferred method is with intravenous calcium gluconate, 10ml of 10% solution over 10 minutes
- intravenous calcium chloride is more likely to cause local irritation
- ECG monitoring is recommended
- coexistent hypomagnesaemia should be corrected, as it impairs PTH secretion and action and may make hypocalcaemia refractory; in severe or symptomatic hypocalcaemia, IV calcium should not be delayed and magnesium should be replaced concurrently
- further management depends on the underlying cause
