What is Hypocalcemia?
Hypocalcemia, popularly known as calcium deficiency, is a decrease in the serum calcium level in the blood below 4.2 mg/dl. Calcium deficiency, which occurs when the body loses calcium or does not take enough calcium into the body, is an important disease. Because 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, regular growth in height and many other organs.
Symptoms of Hypocalcemia
Symptoms of hypocalcemia are usually due 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. When chronic hypocalcemia is associated with hypophosphatemia, it causes rickets and osteomalacia in children. Hypocalcemia, which has serious symptoms, is also a disease that requires urgent intervention. If left untreated, patients' lives can be endangered due to cardiological causes and contraction of the laryngeal muscles.
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 symptom is retraction of the corners of the mouth,
- Bending the patient's hand inward at the wrists 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,
Symptoms Appearing in the Eyes
- Cataract
- Ion accumulation in the eye lens,
Ectodermal Symptoms
- Dry skin
- Flaking of the skin,
- Nails break easily,
- Dry and dull hair,
- Hair loss
- Impairment of teeth and tooth enamel,
- Failure of adult teeth to erupt in children
Causes of Hypocalcemia
Hypocalcemia can cause many diseases. In addition, many diseases also have an impact on the development of hypocalcemia. The most common cause of hypercalcemia is thyroid surgery, but it can have many causes.
Parathyroid Hormone
- Absence of parathyroid gland,
- Parathyroid hormone insufficiency,
- Congenital causes,
- Digeorge syndrome
- X chromosomally inherited or autosomal hypoparathyroidism,
- Polyglandular autoimmune syndrome type 1,
- Parathyroid hormone gene mutation,
- Post Surgical hypoparathyroidism,
- Infiltrative diseases,
- Hemochromatosis
- Respiratory alkalosis
- Calcium sensor activating receptor mutation,
- Target organ resistance,
- Hypomagnesemia,
- Pseudohypoparathyroidism type 1 and type 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,
- Intensive care patients,
- 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. In addition, patients' magnesium levels are also checked in blood tests. In addition, examination of renal function is among the standard investigations performed for diagnosis.
Urine tests and imaging methods are also used to diagnose patients. Since hypocalcemia cannot be diagnosed by a single specialist, it can usually be diagnosed by bone metabolism specialists and endocrinology specialists in research hospitals. In addition, many specialists can work with patients if necessary.
Hypocalcemia Treatment Methods
The aim 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 of patients with severe hypocalcemia are repeated daily and the values are checked regularly. 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 1. and 3. months, you should contact the treating specialist to have your blood values checked again. If the patient has acute hypocalcemia, then patients should have regular blood and urine tests every 6 months after treatment.
In addition to these treatments, diseases that cause hypocalcemia should be identified and treated. Otherwise hypocalcemia will recur. Another condition to be considered in the treatment of hypocalcemia is not to increase blood calcium levels above normal values.
Calcium Gluconate Treatment
It is a treatment method used in cases where calcium levels in patients' blood suddenly drop. These patients also have severe convulsions, prolonged QT interval on ECG, loss of consciousness and heart rhythm disturbances. Care should be taken when giving calcium gluconate to patients and it should be given slowly.
If patients are treated with calcium gluconate but their condition remains unchanged, they are also given magnesium.
Calcium Salts
If patients have been suffering from hypocalcemia for a long time and the calcium level in their blood serum is more than 7.5 mg/dl, then calcium salt therapy is administered. For this purpose, lactate, calcium carbonate and gluconate treatment is applied at a rate of 2-3 grams per day. To support this oral treatment, patients are also given vitamin D supplements. This treatment is used when patients do not have serious symptoms but have low blood calcium levels.
Nutrition of Hypocalcemia Patients
Unfortunately, nutrition is not enough to treat hypocalcemia. The treatment of hypocalcemia, which is a very serious disease, must be done under the supervision of a doctor. However, in the following periods, patients should pay attention to a calcium-rich diet. However, this nutrition should also be done under the control of specialized dietitians. Because too much calcium in the body is also not a desirable result.
Milk and Dairy Products
For a calcium-rich diet, milk and dairy products should be consumed every day. Products such as cheese and yogurt are recommended as they have a higher milk density and therefore a higher calcium value.
Tea, Coffee and Salt
Excessive intake of caffeine and theine reduces calcium absorption in the body. Consuming too much salt accelerates calcium excretion from the kidneys. For this reason, you should be careful when consuming this trio.
Green Vegetables
Green leafy vegetables are known to be rich in calcium. However, since they are pulpy plants, they also reduce the absorption of calcium in the intestines. For this reason, milk and dairy products should be preferred as a source of calcium.
Dry Pulses
Dried legumes are also one of the sources of calcium. For this reason, it is recommended to consume 2 times a week.
Nuts and Dried Fruits
Nuts are particularly rich in calcium. However, nuts and dried fruits, which are also rich in calories, should be eaten in moderation to prevent weight gain.
