Calcium/Magnesium

Question 1

Risk factors for hypocalcemia

Answer 1

1. hypoparathyroidism
2. hypomagnesemia
3. kidney failure
4. Vitamin D deficiency
   5 inadequate intake
5. GI loss
6. Disease process (celiac’s, lactose intolerance, Crohn’s, alcohol use disorder)

Question 2

Manifestations of hypocalcemia

Answer 2

1. tetany, cramps
2. paresthesia
3. dysrhythmias
4. Trousseau’s sign
5. Chvostek’s sign
6. seizures
7. hyperreflexia
8. impaired clotting time

Question 3

Interventions for hypocalcemia

Answer 3

1. seizure precautions
2. IV calcium replacement
3. Daily calcium supplements
4. Vitamin D therapy
5. Monitor for orthostatic hypotension
6. Dietary increase and education

Question 4

How is Calcium given IV?

Answer 4

IV calcium must be administered slowly and the site monitored for extravasation. It is diluted in D5W, NEVER in NS

Question 5

What electrolyte does calcium have an inverse relationship with?

Answer 5

phosphorus

Question 6

Risk factors for hypercalcemia

Answer 6

1. hyperparathyroidism
2. malignant disease
3. Prolonged immobilization
4. dehydration
5. Vitamin D excess
6. thiazide diuretics
7. lithium
8. glucocorticoids
   9 digoxin toxicity
9. overuse of calcium supplements
10. hyperthyroidism

Question 7

Manifestations of hypercalcemia

Answer 7

1. muscle weakness
2. hypercalciuria (kidney stones)
3. dysrhythmias
4. lethargy/coma
5. hyporeflexia
6. pathologic fractures
7. flank pain
8. deep bone pain
9. polyuria, polydipsia, dehydration
   10 hypertension
10. N/V

Question 8

Interventions for hypercalcemia

Answer 8

1. increase mobility
2. Isotonic IVF
3. Dialysis
4. Cardiac monitoring
5. Medications (furosemide, calcitonin, glucocorticoids, bisphosphonates, calcium chelators)

Question 9

Risk factors for hypomagnesemia

Answer 9

1. GI loss
2. alcoholism
3. hypocalcemia
4. hypokalemia
5. DKA
6. hyperparathyroidism
7. malabsorption
8. TPN
9. laxative abuse
10. Acute MI
11. Meds (diuretics)

Question 10

Manifestations of hypomagnesemia

Answer 10

1. paresthesias
2. dysrhythmias
3. trousseau’s sign
4. Chvostek’s sign
5. agitation, confusion
6. hyperreflexia
7. HTN
8. insomnia, irritability
9. anorexia, N/V
10. dysphagia

Question 11

Interventions for hypomagnesemia

Answer 11

1. seizure precautions
2. monitor swallowing
3. dietary measures and education
4. Administer meds (IV mag sulfate, PO mag salts)
5. monitor Urinary output
6. monitor respirations

Question 12

risk factors for hypermagnesemia

Answer 12

1. renal failure
2. excessive mg++ therapy
3. adrenal insufficiency
4. laxative overuse
5. lithium toxicity
6. extensive soft tissue injury or necrosis

Question 13

Manifestations of hypermagesemia

Answer 13

1. hypotension
2. drowsiness
3. bradycardia
4. bradypnea
5. coma
6. cardiac arrest
7. hyporeflexia
8. N/V
9. facial flushing
10. Decreased DTR

Question 14

Interventions for Hypermagnesemia

Answer 14

1. mechanical ventilation
2. IV fluids: LR or NS
3. Administer meds (IV calcium gluconate; Loop diuretics)
4. monitor respiration and blood pressure
5. monitor DTR