From the Guidelines
Hypocalcemia is characterized by several key signs, including tetany, paresthesias, positive Chvostek's sign, and positive Trousseau's sign, which are critical to recognize due to the potential for severe complications, as noted in studies such as 1. These signs reflect the crucial role of calcium in neuromuscular function and other physiological processes. Common manifestations include:
- Tetany (muscle spasms)
- Paresthesias (tingling sensations) particularly around the mouth and in the fingers
- Positive Chvostek's sign (facial muscle twitching when tapping the facial nerve)
- Positive Trousseau's sign (carpal spasm when blood flow to the hand is occluded) Patients may also experience seizures, prolonged QT interval on ECG, mental status changes, and laryngospasm in severe cases. Chronic hypocalcemia can lead to cataracts, dry skin, brittle nails, and dental abnormalities, as calcium is essential for normal nerve conduction, muscle contraction, and cellular signaling, as discussed in 1 and 1. When calcium levels fall below normal (less than 8.5 mg/dL), increased neuromuscular excitability results from altered membrane potentials, highlighting the importance of prompt recognition and management of hypocalcemia to prevent life-threatening complications, such as cardiac arrhythmias and tetany affecting respiratory muscles, as indicated in 1. The management of hypocalcemia should be individualized, particularly in patients with chronic kidney disease (CKD), considering the potential benefits and harms of treatment, including the use of calcium salts and vitamin D sterols, as suggested in 1 and 1. It is essential to balance the treatment of hypocalcemia with the risk of hypercalcemia, especially in CKD patients, where the calcium-phosphorus product should be maintained at <55 mg2/dL, as recommended in 1. Overall, the recognition and management of hypocalcemia require a comprehensive approach, considering the underlying cause, severity of symptoms, and potential complications, as well as the latest clinical practice guidelines, such as those outlined in 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
Hypocalcemia Signs and Symptoms
- Hypocalcemia can manifest with a range of symptoms, from asymptomatic to life-threatening conditions, and may involve almost any organ and system 3
- Acute hypocalcemia symptoms include neuromuscular irritability, tetany, and seizures, which can be rapidly resolved with intravenous administration of calcium gluconate 4
- Chronic hypocalcemia often has more subtle manifestations, and its symptoms can vary depending on the underlying disorder 4
- Disorders that disrupt the metabolism of vitamin D can lead to chronic hypocalcemia, as vitamin D is responsible for increasing the gut absorption of dietary calcium 4
Diagnosis and Management
- The diagnosis of hypocalcemia involves measuring serum calcium levels, and clinical manifestations may range from mild to severe 3
- Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 3
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 3
- In hypoparathyroidism, providing the missing hormone with the use of recombinant human PTH(1-84) has been recently approved as a treatment option 3
Treatment Options
- Parenteral administration of calcium, namely calcium gluconate, calcium chloride, or calcium gluceptate, is used to treat hypocalcemia 5
- Oral administration of calcium chloride solution can promptly correct refractoriness to oral calcium carbonate and vitamin D in patients with achlorhydria 6
- Monitoring of serum chloride and CO2 is needed to avoid hyperchloremic acidosis when using calcium chloride solution 6