A Family Doctor's Tale - HYPOCALCEMIA

DOC I HAVE HYPOCALCEMIA

Hypocalcemia is defined as low Calcium (less than 8.4 mg per liter) in the blood.

Normal blood Calcium varies from 8.4 to 10.4 mg per liter.

Calcium and phosphate are interrelated both regulated by the parathyroid hormones and Vitamin D which control the calcium and phosphate exchange between the blood and three important systems in the body:
1.skeletal
2.gastrointestinal
3.renal

Parathyroid hormones acts mainly on the bones and kidney to raise the blood calcium and increase the phosphate excretion.

Vitamin D increases the intestinal absorption of calcium and phosphate.

Hypocalcemia or low calcium level in the blood is caused by:
1.Hypoparathyroidism from surgical removal of parathyroid gland during thyroidectomy

2.Idiopathic hypoparathyroidism from genetic causes, sometimes unknown causes

3.Malabsorption of calcium, Vitamin D or phosphates from diet.

4.Hypoalbuminemia

5.Chronic renal failure

5.Osteomalacia -lack of mineralization of the bone matrix

6.Rickets - abnormal condition of the bones caused by low Vitamin D

7. Hyperventilation- calcium is bonded to the carbonate in the blood. If the carbon dioxide level in the blood is low, then less calcium is present because the carbonate in the blood is low.

Symptoms of hypocalcemia:
1.neuromuscular hyperexcitabilty resulting  in tetany(a cramp condition of the index finger )

2.convulsions

3.stridor -due to tightening of the muscle of vocal cord

4.smooth muscles tightening

5.diarrhea

Signs:
1.Trousseau's sign - Raising the blood pressure to 200 systolic using the blood pressure cuff on the upper arm can cause the typical sign of tetany or obstretician's finger in hypocalcemia


2.Chvostek's sign - tapping the seventh nerve on the same side of the jaw as the tetany sign can cause the finger to jerk confirming hypocalcemia


Diagnosis:
1.Plasma Calcium levels

2.Blood phosphate level

3.Total serum protein levels
low serum calcium in the presence of low albumin allows a higher free cacium concentration making the patient to be normocalcemic. (normal  blood cacium)

4.Bone density test

Treatment:
1.Intravenous calcium carbonate under cardiac monitoring as excessive calcium may affect the heart

2.oral Calcium supplements is given in most cases as a long term treatment usually with improvement of blood Calcium level

3.Large doses of Vitamin D may be necessary in some cases.

4.Treat underlying cause.

5.Frequent monitoring of progress by blood studies

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

Prevention:
adequate electrolyte replacement after exercise
also after vomiting and diarrhea