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Hypocalcemia

Definition

Calcium is a mineral needed for bone health, muscle movement, and nerve function. Hypocalcemia is lower than normal levels of calcium in your blood.

Causes

Vitamin D helps to absorb calcium from food or supplements. Once in your body, calcium may be stored in the bones or exist in the blood. It may also be excreted through the kidneys. Levels of calcium in the blood are normally regulated by hormones from the parathyroid gland. Hypocalcemia may occur if an illness or medication interferes with this process. The most common cause of hypocalcemia is kidney failure.
Kidney Damage
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Risk Factors

Factors that may interfere with hormones and can lead to hypocalcemia include:
  • Thyroid problems
  • Previous thyroid surgery
  • Autoimmune disease
  • Certain types of cancer
  • Genetic disorders
Factors that may decrease your intake of calcium include:
  • Lack of vitamin D in the diet or through sunlight exposure
  • Lack of magnesium in the diet
  • Digestive problems such as inflammatory bowel disease
  • Certain medications such as diuretics or laxatives
Other factors that may increase your risk of hypocalcemia include:
  • Inflammation of the pancreas
  • Kidney disease or failure—too much calcium excreted
  • Certain medications such as bisphosphonates—move calcium to the bones

Symptoms

Early hypocalcemia may not have any symptoms. When symptoms do occur, they may include:
  • Muscle spasms
  • Tingling and numbness
  • Irregular heartbeat
  • Fatigue
  • Skin changes such as dry, scaly skin
  • Coarse hair that easily breaks
  • Difficulty breathing in newborns

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
  • Blood tests, possibly including genetic testing
  • Urine tests
Images may be taken of your bodily structures. This can be done with X-rays.
The electrical activity of your heart may be tested. This can be done with an electrocardiogram (ECG).

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Medications

You may be given supplements through an IV or pills. Supplements may include:
  • Calcium
  • Magnesium
  • Vitamin D
Medications may also be given to control the condition causing the problem or to increase the amount of calcium in the blood. Medication options may include:
  • Thiazide diuretics to decrease the amount of calcium lost through urination
  • Parathyroid hormone to treat chronic hypoparathyroidism
Your current medications may be changed if they are the cause of your hypocalcemia.

Other Supportive Steps

Your doctor may advise you to increase your intake of calcium and vitamin D. You may be referred to a dietitian.

Prevention

To help reduce your chance of getting hypocalcemia, take these steps:
  • Eat a diet that contains enough calcium and vitamin D. This is especially important during pregnancy.
  • Take calcium or vitamin D supplements if advised by your doctor.
  • Manage conditions such as chronic kidney disease and hypoparathyroidism.

RESOURCES

American Academy of Family Physicians http://www.aafp.org

American Association of Clinical Endocrinologists http://www.aace.com

CANADIAN RESOURCES

The Canadian Society of Endocrinology and Metabolism http://www.endo-metab.ca

Health Canada http://www.hc-sc.gc.ca

References

Cooper M, Gittoes N. Diagnosis and management of hypocalcaemia. BMJ. 2008 June 7;336(7656):1298-1302.

Hypocalcemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 7, 2013. Accessed January 8, 2014.

Hypocalcaemia. Patient UK website. Available at: http://www.patient.co.uk/doctor/Hypocalcaemia.htm. Updated December 14, 2011. Accessed January 8, 2014.

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