Hypocalcemia

Approved Doctor(s) ; Chris M. Adams , Bartolome Burguera • Mar 10, 2022

What is Hypocalcemia?

Hypocalcemia, commonly known as calcium deficiency, is a condition where the serum calcium level in the blood drops below 4.2 mg/dl. This deficiency occurs when the body either loses calcium or fails to take in enough calcium, leading to a significant health issue, as calcium is vital for the body. Calcium is involved in the structure of bones and teeth, the proper functioning of the heart and other muscles, and the regular growth of height, among many other functions.

Symptoms of Hypocalcemia

Symptoms of hypocalcemia are usually related to calcium deposition in soft tissues or neuromuscular irritability. Therefore, the most common symptoms of hypocalcemia are seen in the neuromuscular, ectodermal, and ocular systems. Chronic hypocalcemia, when associated with hypophosphatemia, can cause rickets and osteomalacia in children. With its serious symptoms, hypocalcemia is a disease that requires urgent intervention. If left untreated, patients' lives can be endangered due to cardiological issues and laryngeal muscle contractions.

Neuromuscular Symptoms

Fatigue, anxiety
Memory impairment
Depression
Tingling and numbness in the hands and feet
Seizures
Blurred consciousness
Blurred vision
Double vision
Dizziness
Muscle cramps
Muscle contractions
Muscle tremors
Numbness around the mouth
Difficulty breathing
Chvostek's sign, which is the retraction of the corners of the mouth
Inward bending of the hand at the wrist when taking measurements with a sphygmomanometer
If severe, seizures often occur

Cardiac Symptoms

Arrhythmia
Fainting
Bruising
Chest tightness
Chest pain
Sleep apnea
Congestive heart failure
Low blood pressure

Ocular Symptoms

Cataracts
Ion accumulation in the lens of the eye

Ectodermal Symptoms

Dry skin
Flaking skin
Easily broken nails
Dry and dull hair
Hair loss
Impaired teeth and tooth enamel
Failure of adult teeth to erupt in children

Causes of Hypocalcemia

Hypocalcemia can cause many diseases. Additionally, many diseases can influence the development of hypocalcemia. The most common cause of hypocalcemia is thyroid surgery, but there are many potential causes.

Parathyroid Hormone

Absence of the parathyroid gland
Parathyroid hormone insufficiency
Congenital causes
DiGeorge syndrome
X-linked or autosomal hypoparathyroidism
Polyglandular autoimmune syndrome type 1
Parathyroid hormone gene mutation
Post-surgical hypoparathyroidism
Infiltrative diseases
Hemochromatosis
Respiratory alkalosis
Calcium-sensing receptor mutation
Target organ resistance
Hypomagnesemia
Pseudohypoparathyroidism types 1 and 2

Vitamin D

Vitamin D deficiency
Inadequate dietary Vitamin D intake
Malabsorption (insufficient absorption of Vitamin D)
Rapid elimination of Vitamin D from the body
Drug treatments for epilepsy, bipolar disorder, and neuropathic pain
Target organ resistance
Vitamin D-resistant rickets type 2
Phenytoin drug therapy

Other Causes

Excessive calcium deposition in the skeletal system
Osteoblastic malignancy
Chelation
Phosphate infusion
Infusion of citrated blood cells
Fluoride
Decreased parathyroid hormone response
Critical illnesses
Pancreatitis
Toxic shock syndrome
HIV
Medication treatments
Vitamin D deficiency
Patients in intensive care
Neonatal hypocalcemia
Premature birth
Asphyxia (suffocation due to lack of oxygen)
Diabetic mother
Mothers with hyperparathyroid disorder

How is Hypocalcemia Diagnosed?

Blood tests are used to diagnose hypocalcemia. These tests show high levels of serum phosphate in the patient's blood. Additionally, magnesium levels are checked in blood tests. Renal function is also examined as part of the standard investigations for diagnosis.

Urine tests and imaging methods are also used for diagnosis. Since hypocalcemia cannot be diagnosed by a single specialist, it is usually diagnosed by bone metabolism specialists and endocrinologists in research hospitals. If necessary, multiple specialists may work together to treat the patient.

Hypocalcemia Treatment Methods

The goal of hypocalcemia treatment is to eliminate the biochemical, clinical, and radiologic abnormalities that cause ectopic calcification, nephrolithiasis, hypercalciuria, and hyperphosphatemia. The mainstay of treatment is oral calcium powders and Vitamin D analogs.

In addition, blood tests for patients with severe hypocalcemia are repeated daily, and their values are regularly monitored. Patients with moderate hypocalcemia are monitored by blood tests once a week. Serum parathyroid hormone and 24-hour urinary calcium excretion are also monitored from the start of treatment. This monitoring lasts between 2 and 4 weeks. Patients continue to be closely monitored after the end of treatment. Hypocalcemia patients should contact their treating specialist for blood value checks in the 1st and 3rd months. If the patient has acute hypocalcemia, they should have regular blood and urine tests every 6 months after treatment.

In addition to these treatments, underlying diseases causing hypocalcemia should be identified and treated. Otherwise, hypocalcemia will recur. Another important consideration in the treatment of hypocalcemia is not to increase blood calcium levels above normal values.

Calcium Gluconate Treatment

This treatment is used in cases where calcium levels in the patient's blood suddenly drop. These patients may experience severe convulsions, prolonged QT intervals on ECG, loss of consciousness, and heart rhythm disturbances. Care should be taken when administering calcium gluconate, and it should be given slowly.

If patients do not respond to calcium gluconate treatment, magnesium may also be administered.

Calcium Salts

If patients have long-term hypocalcemia and the calcium level in their blood serum is more than 7.5 mg/dl, calcium salt therapy is administered. This treatment involves lactate, calcium carbonate, and gluconate at a rate of 2-3 grams per day. Vitamin D supplements are also given to support this oral treatment. This treatment is used when patients have low blood calcium levels but do not exhibit serious symptoms.

Nutrition for Hypocalcemia Patients

Unfortunately, nutrition alone is not sufficient to treat hypocalcemia. The treatment of hypocalcemia, a very serious disease, must be conducted under a doctor's supervision. However, in later stages, patients should follow a calcium-rich diet under the guidance of specialized dietitians. Excess calcium in the body is also undesirable.

Milk and Dairy Products

For a calcium-rich diet, milk and dairy products should be consumed daily. Products such as cheese and yogurt are recommended due to their higher milk density and calcium content.

Tea, Coffee, and Salt

Excessive caffeine and theine intake reduce calcium absorption in the body. Consuming too much salt accelerates calcium excretion from the kidneys. Therefore, be cautious when consuming this trio.

Green Vegetables

Green leafy vegetables are known to be rich in calcium. However, because they are fibrous, they can also reduce calcium absorption in the intestines. Therefore, milk and dairy products should be preferred as the primary calcium source.