From the Guidelines
Hypocalcemia typically presents with signs and symptoms such as fatigue, emotional irritability, abnormal involuntary movements, seizures, and cardiac arrhythmias, including prolongation of the QT interval on electrocardiogram, as noted in the most recent study 1.
Key Signs and Symptoms
- Fatigue
- Emotional irritability
- Abnormal involuntary movements
- Seizures
- Cardiac arrhythmias, including prolongation of the QT interval on electrocardiogram These signs and symptoms can occur at any age and may be worsened by biological stress, alcohol, or certain beverages like soda drinks, especially colas 1.
Importance of Early Detection
Early detection and treatment of hypocalcemia are crucial to prevent serious consequences, including cardiac arrhythmias, seizures, and osteopenia/osteoporosis 1.
Clinical Considerations
It is essential to consider hypocalcemia in the differential diagnosis of patients with 22q11.2 deletion syndrome, especially during periods of biological stress or when symptoms such as fatigue, irritability, or abnormal movements are present 1.
Management
Management of hypocalcemia typically involves calcium supplementation, vitamin D if needed, and addressing the underlying cause, such as hypoparathyroidism or hypomagnesemia 1. Regular monitoring of calcium levels, especially during vulnerable times like peri-operatively or perinatally, is recommended to prevent over-correction and potential complications like iatrogenic hypercalcemia or renal failure 1.
From the FDA Drug Label
Infants born to mothers with hypocalcemia should be carefully monitored for signs of hypocalcemia or hypercalcemia, including neuromuscular irritability, apnea, cyanosis and cardiac rhythm disorders. The signs of hypocalcemia include:
- Neuromuscular irritability
- Apnea
- Cyanosis
- Cardiac rhythm disorders 2
From the Research
Signs of Hypocalcemia
The signs of hypocalcemia can vary depending on the severity and duration of the condition. Some common signs include:
- Neuromuscular irritability 3, 4
- Tetany, characterized by muscle cramps, spasms, and weakness 4, 5
- Seizures 3, 4, 5
- Diminished to absent deep tendon reflexes 6
- Papilledema 6
- Mental changes, such as weakness, fatigue, irritability, memory loss, confusion, delusion, and hallucination 6
- Skin changes 6
- Laryngospasm 4
- Focal or generalized tonic muscle cramps 4
- Myocardial dysfunction and prolongation of QT interval 4
- Circumoral numbness 4
- Paresthesias of hands and feet 4
- Muscular cramps 4
Acute vs. Chronic Hypocalcemia
Acute hypocalcemia can cause severe symptoms, such as seizures and tetany, which can be life-threatening if left untreated 3, 4. Chronic hypocalcemia, on the other hand, can have more subtle manifestations, such as muscle weakness and fatigue 3.
Diagnosis and Treatment
Diagnosis of hypocalcemia involves measuring total and ionic calcium, magnesium, parathyroid hormone, and vitamin D metabolites 6. Treatment of hypocalcemia depends on the underlying cause and severity of the condition. Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 4, 7. Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 7. In some cases, recombinant human parathyroid hormone (rhPTH) may be used to treat hypoparathyroidism 7.