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Last Updated: 10/9/2014  

Hypocalcemia

Diagnosis
  • Calculate the corrected serum calcium (calcium level falls 0.8 mg/dL for every 1.0-g/L decrease in serum albumin) or measure the ionized calcium level, or both.

  • Ask patients with known or suspected hypocalcemia about perioral and acral paresthesias, muscle cramps, stiffness, and carpal-pedal spasm.

  • Look for

    • Trousseau and Chvostek signs

    • Tetany, seizures, and papilledema characteristic of acute hypocalcemia

    • Cataracts, dental defects, skin changes, extrapyramidal disorders, and basal ganglia calcifications characteristic of chronic hypocalcemia

    • Bony tenderness characteristic of osteomalacia

  • Obtain a serum intact PTH level.

  • Obtain serum phosphorus, alkaline phosphatase, electrolyte, magnesium, and 25-(OH) vitamin D or 1,25-(OH) vitamin D levels for most patients.

Hospitalization
  • Hospitalize patients with symptomatic hypocalcemia.

  • Hospitalize patients with ionized calcium levels <0.7 mg/dL or total calcium levels <6.5 mg/dL and/or a prolonged QT interval on ECG.

Therapy
  • Treat patients with very low serum calcium levels or severe symptoms with intravenous calcium.

  • Administer vitamin D and calcium to maintain the serum calcium level at 8.5 to 9.0 mg/dL.

  • Provide recombinant parathyroid hormone (teriparatide) therapy in patients with hypoparathyroidism who have persistent hypocalcemia despite treatment with calcium and calcitriol.

  • Treat hypocalcemia caused by hypomagnesemia with magnesium repletion.

  • Treat patients with kidney disease with 1,25-(OH)2 vitamin D3 due to the impaired ability to convert 25-(OH) vitamin D3 to its active form.

  • Treat patients with liver disease with 25-(OH) vitamin D3 due to the impaired ability to hydroxylate vitamin D.

  • Treat other patients with a vitamin D2 that has the lowest overall cost.

  • Ensure daily intake of 1500 to 2000 mg/d of elemental calcium through diet or calcium supplementation.

DOI: 10.7326/d258
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Suzanne M. Jan de Beur, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Mary D. Ruppe, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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