Hypocalcaemia is mild if 1.9 or higher, severe below. Mild hypocalcaemia is usually asymptomatic and can be treated with a follow-up within the next 7 – 10 days, with giving supplements (including Vitamin D if needed), and with consideration of referral to secondary care. Severe hypocalcaemia may need admission for IV treatment if symptoms severe (also, some of the causes – acute pancreatitis and rhabdomyolysis – need admission in themselves).
Causes:
- Hypoparathyroidism
- Chronic renal disease
- Malabsorption
- Hypomagnesaemia (reduces both PTH secretion and its effect on end organs)
- Vitamin D deficiency
- Acute pancreatitis
- Rhabdomyolysis
History:
- Symptoms of hypocalcaemia
- Symptoms of possible underlying causes (malabsorption/pancreatitis/rhabdomyolysis)
- Lifestyle – Vitamin D diet, Vitamin D exposure
- History of neck surgery
- History of autoimmune disease
Investigations:
- Parathyroid hormone
- U&Es
- Magnesium
- Vitamin D
- Fasting phosphate
- ECG – for QT prolongation
Remember that if the PTH is also low, or normal, that’s in line with primary hypoparathyroidism. A raised PTH suggests secondary hyperparathyroidism with an alternative cause of the hypocalcaemia.
(Pulse on-line learning module)
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