Renal System >
Hypocalcaemia

Calcium blood serum level lower than 2.12 mmol/L

Risk Factors
  • Modifiable:
    • Previous head or neck surgery
  • Non-Modifiable:
    • Mental retardation
    • Congenital anomalies
    • Family history
    • Genetic
Aetiology
  • Common causes:
    • Vitamin D deficiency
    • Hypoparathyroidism (autoimmune, genetic, or congenital)
  • Drug Causes:
    • Bisphosphonates
    • Cisplatin
    • Antiepileptics
    • Aminoglycosides
    • Diuretics
    • Proton pump inhibitors
Pathophysiology
  • Low vitamin D levels:
    • Causes a reduction in calcium absorption in the gut
  • Low PTH levels:
    • Loss of calcium in the urine
    • Reduced intestinal absorption of calcium
Clinical Presentation
  • Acute:
    • Paraesthesia
    • Muscle spasms
    • Cramps
    • Seizures
    • Laryngospasm
    • Cognitive impairment
    • Personality disorders
    • ECG may mimic MI or heart failure
  • Chronic:
    • Usually asymptomatic
Investigations
  • Basic investigations:
    • Serum calcium (corrected for albumin)
    • Phosphate
    • Magnesium
    • Electrolytes
    • Creatinine
    • Alkaline phosphatase
    • Parathyroid hormone
    • 25-hydroxyvitamin D
    • Serum pH
    • Complete blood count
  • Further investigations:
    • Ionized calcium
    • 24-hour urinary phosphate, calcium, magnesium, and creatinine
    • 1,25-dihydroxyvitamin D
    • Renal ultrasonography to assess for nephrolithiasis
    • DNA sequencing to exclude genetic mutations
    • Biochemistry in first-degree family members
Management
  • Emergency:
    • IV calcium
    • Cardiac monitoring
  • Long-term:
    • Oral calcium carbonate and calcium citrate
    • Oral vitamin D
Complications
  • Hypercalciuria
  • Nephrocalcinosis
  • Renal impairment
  • Soft tissue calcification

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