Hypocalcemia Questions & Answers

Updated: Jan 22, 2018
  • Author: Manish Suneja, MD, FASN, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Questions & Answers

Overview

What is the presentation of hypocalcemia?

What is the total calcium concentration in the plasma?

How much calcium does each gram of albumin bind to at a plasma pH of 7.4?

What is the role of calcium regulation in the pathogenesis of hypocalcemia?

How are most cases of hypocalcemia discovered?

What are the treatment options for hypocalcemia?

What is the role of ionized calcium in normal physiologic processes?

How much calcium turnover occurs normally each day?

What is the role of the parathyroid hormone (PTH), vitamin D, and calcitonin in the pathogenesis of hypocalcemia?

How are ionized serum calcium changes recognized by the parathyroid gland in the pathophysiology of hypocalcemia?

What is the role of calcium-sensing receptor (CaSR) in the pathophysiology of hypocalcemia?

How is calcium homeostasis maintained?

How is hypocalcemia defined?

What are the triggers of tetany in patients with renal failure and hypocalcemia?

What is the etiology of hypocalcemia?

What is most common cause of hypocalcemia?

What is the role of hypocalcemia in hyperphosphatemia?

How is true hypocalcemia differentiated from factitious hypocalcemia?

How is hereditary hypoparathyroidism differentiated from acquired hypoparathyroidism?

What causes acquired hypoparathyroidism?

What is polyglandular autoimmune disease (PGA I)?

What causes hereditary hypoparathyroidism?

Late-onset hypoparathyroidism is a symptom of which hereditary syndromes?

What characterizes pseudohypoparathyroidism?

How is pseudohypoparathyroidism classified?

What is type Ia pseudohypoparathyroidism?

What is type Ib pseudohypoparathyroidism?

What is type Ic pseudohypoparathyroidism?

What is type II pseudohypoparathyroidism?

What is the etiology of hypomagnesemia?

What causes vitamin D deficiency?

What are the current Recommended Dietary Allowances (RDAs) for vitamin D?

What is the effect of vitamin D deficiency in the elderly?

Which conditions impair the absorption of vitamin D?

What is pseudovitamin D deficiency rickets?

What is the etiology of hereditary vitamin D resistance rickets?

Which sources of vitamin D deficiency are caused by liver disease?

When is calcidiol or calcitriol indicated for the treatment of hypocalcemia?

What causes hypocalcemia in the early stages of renal failure?

What is hungry bone syndrome?

What is the role of hypocalcemia in pancreatitis?

Do cinacalcet and chemotherapy drugs increase the risk of developing hypocalcemia?

Can treatment of hypercalcemia with bisphosphonates cause hypocalcemia?

Can prolonged use of anticonvulsants cause hypocalcemia?

How does foscarnet cause hypocalcemia?

What is denosumab?

Can denosumab cause hypocalcemia?

Can blood or plasma transfusion cause hypocalcemia?

When might sodium phosphate bowel preparation cause acute hyperphosphatemia and subsequent hypocalcemia?

How can radiographic contrast dyes cause hypocalcemia?

Can an excess intake of fluoride cause hypocalcemia?

Can proton pump inhibitors (PPIs) and histamine-2 receptor blockers (eg, cimetidine) cause hypocalcemia?

Which medication effects may cause hypocalcemia?

Can enhanced protein binding and anion chelation cause hypocalcemia?

Which multifactorial causes are most clinically relevant in hypocalcemia emergencies?

How does acute illness cause hypocalcemia?

Can gram-negative sepsis cause hypocalcemia?

Does sepsis increase the mortality rate for patients with hypocalcemia?

Which surgical procedures may cause hypocalcemia?

What is the incidence of hypocalcemia in the US?

What are the risk factors for hypocalcemia?

What are morbidity and mortality rates associated with hypocalcemia?

What are the possible complications of chronic and severe hypocalcemia?

Does the prevalence of hypocalcemia vary among age groups?

Presentation

What should be the focus of past medical history in the evaluation of hypocalcemia?

Which neonates are at increased risk for developing hypocalcemia?

How does hypocalcemia usually present?

How is true hypocalcemia identified?

Which disorders are associated with acute transient hypocalcemia?

Which nutritional deficiency may cause hypocalcemia in elderly patients?

Which drugs may cause hypocalcemia?

Which environmental factors should be considered in the history for hypocalcemia?

What are the possible complications of acute hypocalcemia?

What are the neuromuscular symptoms of acute hypocalcemia?

What are the neurologic symptoms of hypocalcemia?

What are the dermatologic complications of chronic hypocalcemia?

Which physical findings indicate hypocalcemia?

Which head and neck exam findings indicate hypocalcemia?

Which respiratory findings indicate hypocalcemia?

What is the Chvostek sign in patients with hypocalcemia?

What is the Trousseau sign in patients with hypocalcemia?

Which movement abnormalities indicate hypocalcemia

Which peripheral nervous system findings indicate hypocalcemia?

DDX

What is the first step in the evaluation of hypocalcemia?

How are calcium levels corrected in patients with hypocalcemia and low serum albumin levels?

Which gadolinium-based contrast agents interfere with the colorimetric assays for calcium testing?

What are the differential diagnoses for Hypocalcemia?

Workup

How are most cases of hypocalcemia diagnosed?

How is true hypocalcemia differentiated from factitious hypocalcemia?

When are parathyroid hormone (PTH) and vitamin D testing indicated in the evaluation for hypocalcemia?

Which imaging studies are indicated in the evaluation for hypocalcemia?

What is the definitive method for diagnosing hypocalcemia?

How should analysis for the ionized calcium level be performed in the diagnosis of hypocalcemia?

Which factors cause falsely elevated or falsely depressed calcium levels in the evaluation for hypocalcemia?

What stimulates phosphate excretion in patients with hypocalcemia?

What is the usual presentation of patients with renal failure and hypocalcemia?

Are serum magnesium levels measured in the evaluation for hypocalcemia?

What is the role of parathyroid hormone (PTH) testing in the diagnosis of hypocalcemia?

Which tests should be performed if vitamin D deficiency is the suspected cause of hypocalcemia?

How is hypoparathyroidism differentiated from pseudohypoparathyroidism types I and II in patients with hypocalcemia?

What is the role of electrocardiogram (ECG) in the diagnosis of hypocalcemia?

Treatment

What are the treatment options for hypocalcemia?

What are the possible complications of severe hypocalcemia?

Which medications are used to treat hypocalcemic emergencies?

Should ICU patients with hypocalcemia receive calcium supplementation?

What is the management for mild hypocalcemia?

What supportive care should be given prior to direct treatment for severe hypocalcemia?

What is the treatment for severe hypocalcemia?

How is calcium delivered to patients with severe hypocalcemia?

How often should serum calcium be measured in severe hypocalcemia?

When is continuous ECG monitoring indicated in the treatment of severe hypocalcemia?

How can severe hypocalcemia be prevented?

What are the treatment options for chronic hypocalcemia?

What is the treatment of severe hypoparathyroidism in patients with hypocalcemia?

When is recombinant human parathyroid hormone (rhPTH, Natpara) indicated for treatment for chronic hypocalcemia?

How can calcium levels be maintained in patients who have undergone parathyroidectomy?

How is nutritional vitamin D and calcium deficiency treated in patients with hypocalcemia?

Which dietary treatments are available for patients with chronic hypocalcemia?

What information should patients with chronic hypocalcemia be given?

Which specialist consultations may be necessary for hypocalcemia?

How should treatment be directed after the cause of hypocalcemia has been determined?

Medications

What are the goals of pharmacotherapy for hypocalcemia?

Which medications in the drug class Calcium are used in the treatment of Hypocalcemia?

Which medications in the drug class Vitamin D are used in the treatment of Hypocalcemia?

Which medications in the drug class Parathyroid Hormone Analogs are used in the treatment of Hypocalcemia?