What are the clinical manifestations of hypocalcemia?

From the Guidelines

Hypocalcemia presents with a range of clinical manifestations, including neuromuscular irritability, muscle cramps, spasms, tetany, and seizures, as well as cardiovascular and neuropsychiatric symptoms, as noted in studies such as 1 and 1. The clinical manifestations of hypocalcemia can vary depending on the severity and acuity of calcium deficiency.

• The hallmark symptoms include:
  • Neuromuscular irritability, which manifests as paresthesias (tingling) in the perioral region, fingers, and toes
  • Muscle cramps, spasms, and tetany
  • Severe cases may exhibit carpopedal spasm, laryngospasm (which can cause stridor and respiratory distress), and seizures
• Clinicians can detect latent tetany through Chvostek's sign (facial muscle twitching when tapping the facial nerve) and Trousseau's sign (carpopedal spasm induced by inflating a blood pressure cuff above systolic pressure for 3 minutes)
• Cardiovascular manifestations include QT interval prolongation on ECG, which predisposes to arrhythmias, and in severe cases, hypotension and heart failure
• Neuropsychiatric symptoms range from irritability and depression to confusion and psychosis
• Chronic hypocalcemia may lead to cataracts, basal ganglia calcifications, and dental abnormalities
• Patients may also experience dry skin, brittle nails, and coarse hair These manifestations occur because calcium is essential for normal neuromuscular function, cardiac contractility, and numerous cellular processes, with symptoms appearing when ionized calcium levels fall below normal range, as discussed in 1 and supported by the findings in 1. The most recent and highest quality study, 1, highlights the importance of maintaining normal serum calcium levels to prevent the clinical manifestations of hypocalcemia. In managing hypocalcemia, it is crucial to consider the underlying cause, such as hypoparathyroidism, and to monitor and adjust treatment accordingly, as suggested in 1. Regular investigations, including measurements of pH-corrected ionized calcium, magnesium, parathyroid hormone, and creatinine concentrations, are recommended, along with daily calcium and vitamin D supplementation for all adults with conditions associated with hypocalcemia, as noted in 1. Targeted monitoring of calcium concentrations should be considered at vulnerable times, such as peri-operatively, perinatally, or during severe illness, to prevent and manage hypocalcemia effectively, as indicated in 1.

From the FDA Drug Label

Infants born to mothers with hypocalcemia can have associated fetal and neonatal hyperparathyroidism, which in turn can cause fetal and neonatal skeletal demineralization, subperiosteal bone resorption, osteitis fibrosa cystica and neonatal seizures 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 clinical manifestations of hypocalcemia include:

• Neuromuscular irritability
• Apnea
• Cyanosis
• Cardiac rhythm disorders
• Neonatal seizures
• Skeletal demineralization
• Subperiosteal bone resorption
• Osteitis fibrosa cystica 2

From the Research

Clinical Manifestations of Hypocalcemia

The clinical manifestations of hypocalcemia can vary in severity and presentation. Some common symptoms include:

• Muscle cramps or spasms
• Facial, leg, and foot pain
• Seizures
• Tingling in the lips or fingers
• Paresthesia, an unpleasant tingling sensation around the mouth and in the hands and feet
• Tetany, a condition characterized by muscle spasms, particularly in the hands and feet
• Carpopedal spasm, a condition characterized by spasms of the hands and feet
• Involuntary plantar flexion
• Muscle twitching
• Tremor

Severe Clinical Manifestations

In severe cases, hypocalcemia can lead to life-threatening complications, such as:

• Laryngospasm
• Stridor
• Bronchospasm
• Wheezing
• Severe irregularities in the normal heart beat
• Coma

Treatment and Management

Treatment of hypocalcemia typically involves correcting the underlying cause of the condition, as well as administering calcium and vitamin D supplements to stabilize calcium levels 3, 4, 5. In severe cases, intravenous calcium replacement may be necessary to rapidly correct hypocalcemia 3, 6.

Associated Conditions

Hypocalcemia can be associated with other conditions, such as hypoparathyroidism, a rare endocrine disorder characterized by low or absent secretion of parathyroid hormone (PTH) 4, 5. Hypomagnesemia, a condition characterized by low magnesium levels, can also contribute to hypocalcemia 7.