It is a plasma calcium level below 8.

5 mg/dl

Etiology
Decreased total calcium :

Hyper phosphatemia Loop diuretics

Immobility Mg+ deficiency

Removal or destruction of parathyroid gland

Chronic alcoholism Hypoalbuminemia,

Hypothyroidism , Diarrhea

Polyuric phase Steatorrhoea Wound drainage Lactose intolerance

Malabsorbtion syndrome
ESRD Inhibition of Ca absorption from GI Inadequate oral intake of vit D Acute pancreatitis

Decreased ionized Ca+ Alkalosis Excess administration of citrate blood Hyper proteinimia Drugs such as ca chelators

Hypocalcemia
Clinical Manifestations

CAT go Numb
Convulsion Arrythmia Tetany Numbness/ paresthesia in hands & feet
Acute: serum Ca <7.5mg/dL Neurologic: tetany (from paresthesias to seizures and bronchospasm) Cardiac: prolonged QT, hypotension, heart failure, arrhythmia Papilledema Psychiatric manifestations Chronic: EPS, dementia, cataracts, dry skin

 Numbness and tingling in extremities and region

around mouth

Laryngeal spasm
hyperactive reflexes

Positve Trousseaus sign, positive chvosteks sign ,

muscle cramps, pathological fractures, prolonged bleeding time

Hypocalcemia (<9.0mg/dL)
Assessment findings:

Neuro Irritable muscle twitches.

Positive Trousseaus sign. Positive Chvosteks sign.

Resp. Resp. failure d/t muscle tetany. CV

Dec. HR., dec. BP, diminished peripheral pulses GI Inc. motility. Inc. BS. Diarrhea

Positive Trousseaus Sign

Positive Chvosteks Sign

Hypocalcemia:
Long QT that is due to a long ST segment, which is different from long QT due to congenital long QT syndrome, drugs, or hypokalemia. T wave is not wide, there is no T wave abnormality.

 Long QT interval with

normal T waves Prolongation of the ST segment with little shift from the baseline

Complication

airway obstruction possible respiratory arrest from laryngospasm ventricular dysrythmias cardiac arrest heart failure

Diagnosis
Total serum Ca+
Serum albumin Serum Mg+

Serum phosphate
PTH ECG

Management

Hypocalcemia (<9.0mg/dL)
Interventions/Treatment Restore Ca by oral milk,Ca rich food,cheese Drug Therapy

Calcium supplements Vitamin D

Diet Therapy

High calcium diet

Seizure precautions

Prevention of Injury

Therapy
Correct for albumin
Ca lower by .8mg/dL for every 1g/dL reduction in serum albumin or check ionized calcium

Level can be altered by acid/base disturbance Symptomatic or acute serum Ca <7.5mg/dL:

IV Calcium gluconate 1-2g(amp) over 10-20min (temporary rise

for 2-3 hrs, must be followed by slower infusion 50mL/hr if Ca remains low)

Asymptomatic and serum Ca >7.5mg/dL or chronic:

Oral therapy: calcium carbonate or citrate 1-2g/day (500mg

bid-qid)

Add Vitamin D in following cases:

Hypoparathyroidism: Vitamin D (Calcitriol .25-.5mcg bid) Vitamin D deficiency: 50,000IU/week for 6-8 weeks then 800-

1000IU daily

Erogcalciferol (D3) Cholecalciferol (D2)

Therapy
Goals of therapy:
Treat and prevent manifestations of hypocalcemia In hypoparathyroidism: to raise serum Ca to low-normal range (8.0-

8.5mg/dL)

Adverse Effects:
Rapid infusion- bradycardia, hypotension
Extravasation- tissue necrosis Hypercalcemia Hypercalciuria

Constipation
Hypophosphatemia Milk-alkali syndrome

 1.Asymtomatic hypocalcemia is treated with oral calcium chloride, calcium gluconate or calcium lactate 2.Tetany from acute hypocalcemia needs IV calcium chloride or calcium gluconate to avoid hypotension bradycardia and other dysrythmias 3.Chronic or mild hypocalcemia can be treated by consumption of food high in calcium

Nursing responsibility
Oral ca salt

administer 1-1.5 hrs after meals and bed time give Ca tab with a full glass of water
IV

Asses IV line for pattency administer in to largest available vein do not administer with bi carbonte and phosphate continuous ECG monitoring while administering to patient taking digitalis slow iv or compatible pareneral fluid (NS,D5W)