hypocalcemia
- related: Endocrine, Parathyroid, hypocalcemia after osteoporosis treatment, Hypercalcemia
- tags: #note
Causes
- hyperphosphatemia: check ionized Ca.
- IV bicarb can cause hypocalcemia and deposition of calcium phosphate in renal tubules
- hypocalcemia is common abnormality after massive transfusion
Symptoms
- mild: muscle cramps, tingling sensations
- severe: seizure
- long QT
Treatment
- Usually do not need repletion unless ionized < 1.0. For hyperphosphatemia, repleting Ca can cause Ca-phos deposition and calciphylaxis.
- Give caltritriol (vit D) to raise Ca.
- Calcitriol suppresses PTH. Do not give if PTH too low (could cause bone disease). Give 0.25 mcg/day starting dose
Minor
- oral calcium: calcium citrate or carbonate, aka tums
- Calcitriol: activated vitamin D, necessary for Ca absorption
Severe
- symptomatic, prolonged QTc, Ca < 7.5
- IV calcium gluconate bolus followed by infusion
- 10 g in 1L NS over 24 hours
- start PO at same time
- typically ordered by endocrine consult
Links to this note
- Parathyroid
- Hypercalcemia
- related: Endocrine, hypocalcemia
- electrolyte disorders
- hypocalcemia is common abnormality after massive transfusion
- blood products have citrate preservative that binds to endogenous calcium after transfusion, leading to hypocalcemia
- rhabdomyolysis induced AKI
- Intravenous bicarbonate should only be used after diuresis is established with volume repletion. It should not be used if pH is >7.5, serum bicarbonate is >30 mEq/L (30 mmol/L), and/or severe hypocalcemia is present. Intravenous bicarbonate can cause symptomatic hypocalcemia and can promote deposition of calcium phosphate in the renal tubules.
- hypocalcemia after osteoporosis treatment
- related: hypocalcemia, vitamin D deficiency
- calciphylaxis
- related: Nephrology, hypocalcemia