From the Guidelines
Hypocalcemia can cause paresthesias, which are abnormal sensations like tingling, numbness, or "pins and needles" typically affecting the fingers, toes, and perioral region, and treatment involves addressing the underlying cause and correcting calcium levels, as seen in patients with 22q11.2 deletion syndrome 1.
Symptoms of Hypocalcemia
The symptoms of hypocalcemia related to paresthesias include:
- Tingling or numbness in the fingers, toes, and perioral region
- Muscle cramps
- Tetany
- Seizures
- Cardiac arrhythmias These symptoms occur because calcium is an essential ion for nerve conduction and muscle contraction, and when levels fall below normal (8.5-10.2 mg/dL), nerve cells become hyperexcitable, leading to these abnormal sensations.
Treatment and Management
Treatment of hypocalcemia involves:
- Calcium supplementation, with oral calcium carbonate or calcium citrate at 1000-2000 mg elemental calcium daily, divided into 2-3 doses
- Vitamin D supplementation (800-1000 IU daily) to enhance calcium absorption
- Addressing underlying causes of hypocalcemia, such as hypoparathyroidism, vitamin D deficiency, kidney disease, or certain medications
- Regular blood tests to monitor calcium levels and ensure levels return to normal and remain stable It is also important to note that patients with significant or symptomatic hypocalcemia could still benefit from correction to prevent adverse consequences, as suggested by the Kidney Disease: Improving Global Outcomes 2017 clinical practice guideline update 1.
Key Considerations
- Hypocalcemia can be associated with fatigue, emotional irritability, abnormal involuntary movements, seizures, and cardiac arrhythmias, as seen in patients with 22q11.2 deletion syndrome 1.
- The prevalence of hypocalcemia may have increased after the introduction of calcimimetics in patients receiving dialysis, and an individualized approach should be used to treat hypocalcemia rather than recommending correction of hypocalcemia in all patients 1.
- New pathophysiologic understanding of phosphate regulation and the roles of FGF23 and soluble Klotho in early CKD have prompted studies investigating phosphate-lowering therapies in patients with CKD who have not yet developed hyperphosphatemia 1.
From the Research
Symptoms of Hypocalcemia Related to Paresthesias
- Paresthesia is an unpleasant tingling sensation that can occur in people with hypocalcemia, particularly around the mouth and in the hands and feet 2
- This symptom is a result of low blood calcium levels, which can interfere with normal muscle contraction and nerve conduction 2
- Other symptoms that may occur in conjunction with paresthesia include muscle cramps and severe spasms known as "tetany" that affect the hands and feet 2
- Hypocalcemia can also cause more severe symptoms, such as seizures, severe irregularities in the normal heart beat, as well as laryngospasm, stridor, bronchospasm, and wheezing 2, 3
- In some cases, hypocalcemia can lead to bilateral basal ganglia calcification, also known as Fahr's syndrome, which can cause a range of symptoms including seizures and movement disorders 3
Causes of Hypocalcemia
- Hypoparathyroidism, characterized by impaired secretion of parathyroid hormone (PTH), is a classic cause of chronic hypocalcemia 4, 2
- Disorders that disrupt the metabolism of vitamin D can also lead to chronic hypocalcemia, as vitamin D is responsible for increasing the gut absorption of dietary calcium 4
- Other causes of hypocalcemia include post-surgical hypoparathyroidism, which can occur after thyroidectomy surgery 3