Hypocalcemia: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Paresthesias (mouth, fingertips) | |||
*Incr DTRs | |||
*Cramps | |||
*[[Weakness]] | |||
*[[Confusion]] | |||
*[[Seizures]] | |||
*Chvostek/Trousseau, Tetany | |||
*[[Hallucinations]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Treatment== | ==Treatment== | ||
''Avoid empiric treatment in patients taking digoxin due to risk for [[Stone Heart]]'' | ''Avoid empiric treatment in patients taking digoxin due to risk for [[Stone Heart]]'' | ||
*Asymptomatic | |||
**Calcium gluconate 1 gm PO Q6hrs | |||
**Vitamin D (calcitriol) 0.2 mcg BID | |||
*Symptomatic | |||
**Calcium gluconate/chloride 10mL of 10% soln IV over 10min | |||
*Correct [[hypomag]] at same time (otherwise PTH is inhibited) | *Correct [[hypomag]] at same time (otherwise PTH is inhibited) | ||
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*[[Electrolyte Abnormalities (Main)]] | *[[Electrolyte Abnormalities (Main)]] | ||
== | ==References== | ||
[[Category:FEN]] | [[Category:FEN]] | ||
Revision as of 23:54, 1 July 2015
Background
- Low <8.5 (<2.0 ionized)
- Low! <6.5 (<1.5 ionized)
- Correct for hypoalbumimia
- Corrected Ca = (0.8 * (Normal Alb - Pt's Alb)) + Serum Ca
Causes
- Misc
- Shock
- Sepsis
- Pancreatitis
- Hypomag
- Rhabdo (phosphate overload)
- Massive transfusion
- Decreased absorption
- Vit D deficiency
- Increased excretion
- Endocrine
- Drugs
Clinical Features
- Paresthesias (mouth, fingertips)
- Incr DTRs
- Cramps
- Weakness
- Confusion
- Seizures
- Chvostek/Trousseau, Tetany
- Hallucinations
Differential Diagnosis
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Diagnosis
- Trousseau's Sign (Mod to high SN and SP)
- Inflate BP cuff for 2-3 mins
- Positive = Muscle contractions of the hand and wrist
- Chvostek's Sign (Low SN and SP)
- Tapping on the face just anterior to the ear and just below the zygomatic bone
- Positive = Ipsilateral facial twitching
Treatment
Avoid empiric treatment in patients taking digoxin due to risk for Stone Heart
- Asymptomatic
- Calcium gluconate 1 gm PO Q6hrs
- Vitamin D (calcitriol) 0.2 mcg BID
- Symptomatic
- Calcium gluconate/chloride 10mL of 10% soln IV over 10min
- Correct hypomag at same time (otherwise PTH is inhibited)