Hypocalcemia Signs and Symptoms

Signs and Symptoms

Definition

True Hypocalcemia

Decrease in ionized Ca
Symptoms are observed only with decreases in ionized Ca concentration

Factitious Hypocalcemia

Decrease in total Ca, but not ionized Ca
Majority is due to hypoalbuminemia caused by chronic illness, psoriasis, malnutrition, volume expansion

Etiology

Absence of PTH or Parathyroid Glands

Congenital
Postsurgical hypoparathyroidism
Infiltrative disorders (eg hemochromatosis)
Hypoparathyroidism secondary to radioactive iodine thyroid ablation
Autoimmune hypoparathyroidism (isolated or as part of Polyglandular Autoimmune Syndrome Type 1)

Impaired Secretion of PTH

Hypomagnesemia
Respiratory alkalosis
Activating mutations of the Ca sensor

Vit D Related

Vit D deficiency
Accelerated Vit D loss
Impaired 25-hydroxylation
Impaired 1-α-hydroxylation (eg renal failure)
Target-organ resistance

Target Organ Resistance to PTH

Hypomagnesemia
Pseudohypoparathyroidism (Type I and II)

Others

Chelation with drugs
Pancreatitis
Septic shock
Hungry bone disease

Signs and Symptoms

Neurological
- Tetany
  - Trousseau and Chvostek signs
- Paresthesia around the mouth, fingers and toes
- Muscle cramps, spasms
- Seizures
- Dementia
- Calcification of the basal ganglia

Laryngospasm
Ophthalmological
- Cataracts
- Papilledema
Dermatological
- Epidermal changes eg dry skin, coarse hair, brittle nails
Cardiovascular
- ECG abnormalities
  - Eg prolonged QT intervals and QRS and ST changes which mimic myocardial infarction (MI)

Pathophysiology

Calcium Regulation

Parathyroid hormone
- Bone: Activates osteoclasts leading to bone resorption and release of Ca
- Kidney: Converts 25-dihydroxyvitamin D to 1,25-dihydroxyvitamin D (active form of vit D) and stimulates calcium reabsorption

1,25-dihydroxyvitamin D
- Gastrointestinal tract: Promotes calcium absorption
- Skin: Exposure to ultraviolet light produces vit D; diet is also a good source of vit D
- Liver: Converts vit D to 25-dihydroxyvitamin D

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