Hypocalcaemia

Question 1

What are the symptoms of Hypocalcaemia?

Answer 1

Peripheral irritability (tetany, cramps, carpo-pedal spasm)
Central irritability (seizures)
Depression/anxiety
Perioral paraesthesia
Cataracts

Question 2

What is a carpo-pedal spasm?

Answer 2

Wrist flexion/fingers drawn together

- If happens after brachial occlusion = Trosseau's sign
- If twitches when tapping facial nn = Chvostek's sign

Question 3

How can the causes of Hypocalcaemia be separated?

Answer 3

With low PTH

With high PTH

Question 4

What are the causes of Hypocalcaemia with low PTH?

Answer 4

Idiopathic/1o hypoparathyroidism
Post-thyroid/parathyroid surgery
Post neck irradiation
Infiltration (sarcoid, malignancy)
Congenital absence of gland (Di George)
Severe hypomagnesia

Question 5

What are the causes of Hypocalcaemia with high PTH?

Answer 5

Vit D deficiency
Acute pancreatitis
Alkalosis
Acute hyperphosphataemia (renal failure, rhabdo, tumour lysis)
Drugs (bisphosphonates, calcitonin)

Question 6

What investigations are appropriate in suspected hypocalcaemia?

Answer 6

Serum Ca (low)
Serum PTH (high/low) --> If low check antibodies
Serum Vit D
ECG (prolonged QT)

Question 7

What is the management of hypocalcaemia?

Answer 7

Mild/mod sx –> AdCal
Sev sx –> Calcium gluconate IV, 10mls of 10% bolus then maintenace AND AdCal
Find/treat cause