From the Guidelines
Hypocalcemia symptoms include fatigue, emotional irritability, abnormal involuntary movements, seizures, and cardiac arrhythmias.
Common Symptoms
- Fatigue
- Emotional irritability
- Abnormal involuntary movements
- Seizures
- Cardiac arrhythmias, including prolongation of the QT interval 1
Clinical Presentation
Hypocalcemia can also predispose to osteopenia/osteoporosis and may be worsened by alcohol or carbonated beverages such as colas 1. In addition, hypocalcemia can lead to cardiac dysrhythmias, particularly when ionised Ca2+ levels are below 0.8 mmol/L 1.
Diagnosis and Treatment
Regular investigations, including measurements of pH-corrected ionized calcium, magnesium, parathyroid hormone, and creatinine concentrations, are recommended to diagnose and manage hypocalcemia 1. Treatment with calcium chloride or calcium gluconate may be necessary to correct hypocalcemia, particularly in patients with severe symptoms or those requiring massive transfusion 1.
Special Considerations
In patients with chronic kidney disease (CKD), hypocalcemia can contribute to the pathogenesis of secondary hyperparathyroidism and renal osteodystrophy, and individualized treatment approaches may be necessary to manage hypocalcemia in these patients 1.
From the Research
Symptoms of Hypocalcemia
The symptoms of hypocalcemia can vary depending on the severity and duration of the condition. Some common symptoms include:
- Neuromuscular irritability, tetany, and seizures, which are rapidly resolved with intravenous administration of calcium gluconate 2
- Diminished to absent deep tendon reflexes, papilledema, mental changes (weakness, fatigue, irritability, memory loss, confusion, delusion, hallucination), and skin changes 3
- Muscle weakness, fatigue, nausea, vomiting, and pancreatitis 4
- Hypocalcemic tetany, which is the consequence of severely lowered calcium levels (<2.0 mmol/l), usually in patients with chronic hypocalcemia 4
Acute vs. Chronic Hypocalcemia
Acute hypocalcemia can cause severe symptoms such as tetany, seizures, and hypocalcemic tetany, which require rapid intravenous calcium replacement 2, 4. Chronic hypocalcemia, on the other hand, can have more subtle manifestations and may require long-term management with oral calcium and vitamin D supplementation 2, 5.
Underlying Causes
The underlying causes of hypocalcemia can include:
- Impaired secretion of parathyroid hormone (PTH) 2
- Disorders that disrupt the metabolism of vitamin D 2
- Decreased calcium absorption or increased loss from the gastrointestinal tract 3
- Parathyroid hormone deficiency or resistance 3, 4
- Certain medications, such as bisphosphonates, cisplatin, antiepileptics, aminoglycosides, and proton pump inhibitors 6