Hypocalcaemia Flashcards
(9 cards)
What is the NICE definition of hypocalcaemia?
Adjusted serum calcium
< 2.2 mmol/L
How is hypocalcaemia severity classified according to NICE?
Mild: Serum adjusted calcium < 1.9 -2.2 mmol/L and asymptomatic.
Severe: Serum adjusted calcium
< 1.9 mmol/L and/or symptomatic
What are the common symptoms of hypocalcaemia?
- Perioral paraesthia
- Paraesthesia (fingers, toes)
- Muscle cramps, tetany, carpopedal spasm
- Chvostek and Trousseau signs
- Cardiac: arrhythmias, bradycardia, hypotension, prolonged QT
- Mental changes: anxiety, confusion, irritability
- Seizures, bronchospasm, laryngospasm
What are common causes of hypocalcaemia?
- Vitamin D deficiency
- Hypomagnesaemia
- Chronic Kidney disease
- Hypoparathyroidism or post-parathyroidectomy
- Malabsorption, inadequate dietary intake
- Large volume blood transfusion (haemodilutional hypocalcaemia)
- Severe pancreatitis, septic shock
- Drugs (e.g., bisphosphonates, PPIs)
- Iatrogenic (post thyroidectomy)
What initial investigations should be performed in suspected hypocalcaemia?
- Serum magnesium
- Parathyroid hormone (PTH)
- Vitamin D levels
- ECG (for QT prolongation)
- UEs, phosphate, albumin
How should severe or symptomatic hypocalcaemia be managed acutely?
IV calcium gluconate 10% 10–20 mL in 50–100 mL 5% glucose or 0.9% saline over 10–20 minutes with ECG monitoring
Repeat as needed or start infusion if persistent
Correct hypomagnesaemia first
How should mild or asymptomatic hypocalcaemia be managed?
Oral calcium supplements (e.g., Calcichew Forte, Adcal D3)
Add vitamin D if persistent
Monitor serum calcium regularly
What are special considerations for treating hypocalcaemia in chronic kidney disease?
Use activated vitamin D analogues (e.g., alfacalcidol, calcitriol)
What is a key point in correcting hypocalcaemia?
Always correct hypomagnesaemia before or alongside calcium, as hypocalcaemia may not resolve otherwise.
