Hypocalcaemia

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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About Dr Sarah

I'm a GP with a husband and two young children.
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