Hypocalcemia

Jump to navigation Jump to search

For patient information, click here

Template:DiseaseDisorder infobox

Hypocalcemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypocalcemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypocalcemia On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hypocalcemia

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypocalcemia

CDC on Hypocalcemia

Hypocalcemia in the news

Blogs on Hypocalcemia

Directions to Hospitals Treating Hypocalcemia

Risk calculators and risk factors for Hypocalcemia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Hypocalcemia can be the consequence of multiple disease processes, some of which will be mentioned in the following discussion. The most common cause is the inability to mobilize calcium from bone which is primarily induced by decreased levels of the parathyroid hormone (PTH) due to derangement of the parathyroid gland function (ie, the gland responsible of calcium homeostasis) or vitamin D deficiency.

  • Hypoparathyroidism: It signifies diminished activity of the parathyroid gland due to multiple reasons: autoimmune destruction (included in the polyglandular autoimmune syndrome type I), resection of the glands as a possible complication of total thyroidectomy or genetic diseases affecting the gland's function. A second entity that should be mentioned is pseudohypoparathyroidism which is characterized by normal gland function but inability of the PTH-target organs (bone and kidney) to respond to PTH. Patients present with hypocalcemia but high PTH levels.

Complete Differential Diagnosis of the Causes of Hypocalcemia

(In alphabetical order)

Complete Differential Diagnosis of the Causes of Hypocalcemia

(By organ system)

Cardiovascular No underlying causes
Chemical / poisoning Alcohol abuse
Dermatologic No underlying causes
Drug Side Effect Anticonvulsant therapy, Chelation therapy, Diuretic therapy, Drugs, Enemas, laxatives, Steroid therapy
Ear Nose Throat No underlying causes
Endocrine Absent parathyroid hormone (PTH), Acquired hypoparathyroidism, Adrenocortical hyperplasia, Deficient PTH, Excessive secretion of calcitonin, Familial hypocalcemia, Following thyroidectomy, Hereditary hypoparathyroidism, "Hungry Bone Syndrome" following parathyroidectomy, Hypoparathyroidism, Hypoproteinemia, Medullary carcinoma of the thyroid, Osteitis fibrosa following parathyroidectomy, Osteoporosis, Pseudohypoparathyroidism, Thyroid cancer
Environmental Decreased ultraviolet/sun (vitamin D deficiency), Defective Vitamin D metabolism, Exposure to hydrofluoric acid
Gastroenterologic Acute pancreatitis, Cirrhosis, Decreased dietary intake, Eating disorders, Enemas, laxatives, Intestinal malabsorption, Malabsorption, Maldigestion, Pancreatitis, Rickets, Short bowel syndrome, Vitamin-D dependent rickets, type I
Genetic DiGeorge's Syndrome, Familial hypocalcemia
Hematologic Hypoalbuminemia (pseudohypocalcemia), Transfusion of citrated blood, Tumor lysis syndrome
Iatrogenic No underlying causes
Infectious Disease Sepsis, Septic shock
Musculoskeletal / Ortho Enhanced bone formation, Excessive secretion of calcitonin, Neonatal tetany, Osteitis fibrosa following parathyroidectomy, Osteoporosis, Rickets, Vitamin-D dependent rickets, type I
Neurologic No underlying causes
Nutritional / Metabolic Absent active vitamin D, Decreased dietary intake, Hyperphosphatemia, Intestinal malabsorption, Intravenous phosphate administration, Magnesium depletion, Rickets, Vitamin D deficiency
Obstetric/Gynecologic Breast cancer
Oncologic Breast cancer, Bronchial cancer, Medullary carcinoma of the thyroid, Osteoblastic metastases, Thyroid cancer, Tumor lysis syndrome
Opthalmologic No underlying causes
Overdose / Toxicity Magnesium over supplementation, Prolonged use of medications/laxatives containing magnesium
Psychiatric Eating disorders
Pulmonary Bronchial cancer, Hyperventilation
Renal / Electrolyte Acute renal failure, Alkalosis, Chronic renal failure, Hypomagnesemia, Hypoproteinemia, Increased diuresis with physiologic saline solution, Intravenous phosphate administration, Kidney diseases with reduced formation of activated vitamin D, Magnesium depletion, Magnesium over supplementation, Nephrotic syndrome, Renal failure, Rhabdomyolysis, Severe acute hyperphosphatemia
Rheum / Immune / Allergy DiGeorge's Syndrome, Osteitis fibrosa following parathyroidectomy, Polyglandular autoimmune syndrome
Sexual No underlying causes
Trauma Burns
Urologic Acute renal failure, Chronic renal failure, Hypoproteinemia, Renal failure
Miscellaneous Postoperative, Transfusion of citrated blood

Diagnosis

History and Symptoms

Signs

Clinical Features Associated with Hypocalcemia

Laboratory Findings

Suggested initial laboratory studies include the following:

Additional laboratory studies to be obtained as part of a more complete evaluation include the following:

Electrocardiographic Findings

  1. Prolongation of the QTc interval is the major EKG finding
  2. There is a lengthening of the interval between the end of the QRS and the beginning of the T wave (i.e. ST-segment lengthening).

EKG examples

Prolonged QTc interval due to hypocalcemia


Management

References

Related chapters

Resources


Template:WikiDoc Sources