Hypocalcaemia
Curriculum item: Calcium balance
approach to etiology
- What's the PTH?
- What's the Vit D?
low PTH (i.e. inappropriately low)
- primary hypoparathyroidism - i.e. destruction of parathyroids, eg after thyroidectomy...
- dysregulation of PTH secretion
high or normal PTH
- Vit D deficiency → 2o to renal failure?
- altered protein binding
- PTH resistance - low Mg!
- Depletion
- TLS - causing high phosphate
- drugs
Or, ↑ intake, redistribution, ↑ output
↑ loss of Ca from circulation
- acute pancreatitis
- 'hungry bone syndrome' - post-parathyroidectomy
- hyperphosphataemia
etiology by acid-base disturbance
- Metabolic alkalosis – citrate toxicity
- Metabolic acidosis – acute renal failure, tumour lysis syndrome, rhabdomyolysis, pancreatitis, ethylene glycol poisoning, hydrofluoric acid, Sepsis, burns
ECG features
management approach
Replace Mg along with Ca. Check Phos (↑ phos = binding to calcium)
Refractory hypocalcaemia: recombinant PTH