HypocalcemiaE83.58

In hypocalcemia (see calcium below), the plasma calcium concentration is < 2.2 mmol/l, and both protein-bound and ionized calcium may be affected.

Protein-bound calcium may be decreased:

• in the case of hypalbuminemia due to nephrotic syndrome or also
• malnutrition (normal ionized calcium).

Decreased ionized calcium may be:

• caused by parathyroid insufficiency and vitamin D deficiency (PHT high, phosphate low)
• further in therapy with anticonvulsants (e.g. phenytoin) and in pancreatitis.
• If the magnesium level is low at the same time, alcoholism or a malabsorption syndrome may be the cause. Drugs can also cause this constellation (loop diuretics, gentamicin, cisplatin).

The main symptom is the increased excitability of the entire nervous system, which can result in seizures with preserved consciousness, pawing, glottis spasm, spasms and paresthesias (hypocalcemic tetany).

Chvostek's sign: Tapping of the facial nerve in the cheek area causes twitching of the corners of the mouth in positive cases.

Trousseau's sign: When a blood pressure cuff is applied to the arm, a pawing position occurs in the positive case. However, these clinical signs are more likely to occur in marked hypocalcaemia. Chronic and mild forms are usually asymptomatic.

Causal

Symptomatic: In tetany: calcium i.v. (e.g. 10ml calcium gluconate 10% slowly i.v.); possibly compensation of existing magnesium deficiency

Long-term treatment: oral substitution of calcium, possibly + vitamin D