Hypocalcaemia can life threatening, due to arrhythmias and seizures.
Severity – Adjusted Calcium (Ca)
- Mild: >1.9mmol/l
- Severe: ≤1.9mmol/l OR Symptomatic
Signs/Symptoms
- Paraesthesiae: peri-oral & digits
- Trousseau’s sign (spasm of hand and wrist, when blood pressure cuff >20mmHg over systolic BP for 2-5min, very unpleasant for patient)
- Chvostek’s sign (facial spasm on tapping facial nerve, anterior to earlobe and below the zygomatic arch)
- Tetany & carpopedal spasm
- Laryngospasm
- Dysrhythmias: Prolonged QT & arrhythmia
- Seizures
Causes
- Parathyroid disruption, is the commonest (either from parathyroid or thyroid pathologies)
- Vit D deficiency
- Rhabdomyolysis
- Pancreatitis
- Transfusion
- Hypomagnesaemia
Treatment
Mild: Adjusted Calcium >1.9mmol/l
- Commence Oral Calcium supplementation
- Treat underlying cause (send: Vit D, PTH, Mg, U&E, Phosphate)
- Likely discharge to GP follow-up
Severe: Adjusted Calcium ≤1.9mmol/l OR Symptomatic
- Calcium Gluconate
- Initial – 10ml 10% Calcium Gluconate I.V. 10min (may be repeated until symptoms resolve)
- Maintenance – 100ml 10% Calcium Gluconate diluted in 1000ml 0.9% NaCl/5% Glucose (10-20hours)
- Treat underlying cause (send: Vit D, PTH, Mg, U&E, Phosphate)
- Will need admision
