Calcium homeostasis in the body is a complex interplay between several different hormones or hormone-like substances, such as Parathyroid hormone(PTH), Vitamin D, and calcitonin. Disorders of calcium metabolism are encountered pretty frequently in routine clinical practice. Hypocalcemia is not as frequently encountered as hypercalcemia, but it can be potentially life threatening if not appropriately recognized and treated promptly.
The causes of hypocalcemia can be divided into three broad categories:
PTH DEFECIENCY (low or low normal serum PTH)
There is no literature on quantification of hypocalcemia in general. However, the reported prevalence of transient hypocalcemia after thyroidectomy varies between 6.9 to 49% and between 0.4 to 33% for permanent hypocalcemia. In general, renal failure by far remains the most common cause of hypocalcemia followed by vitamin D deficiency, magnesium deficiency, acute pancreatitis, etc.
The history and physical exam of patients with suspected hypocalcemia should be conducted with two underlying principles in mind. First, to uncover the potential manifestations of hypocalcemia like:
The second part of history and physical should focus on determining the cause of hypocalcemia such as recent head and neck surgery, family history of similar problems, history of kidney disease, alcohol abuse (hypomagnesemia), psychiatric history, etc.
Work up of hypocalcemia can be thought of in following parts:
Management of Hypocalcemia can be divided into two broad categories:
Check a magnesium level when faced with hypocalcemia since its an important and easily correctable cause of hypocalcemia.
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