Hypocalcemia natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Overview

The clinical presentation of hypocalcemia vary widely, ranges from asymptomatic symptoms to life-threatening complications.The main factors that influence the serum calcium levels are parathyroid hormone (PTH), vitamin D, the calcium ions, and phosphate.Hypocalcemia is commonly encountered in patients who are hospitalized. Undertreatment or improper treatment of hypocalcemic emergencies can lead to significant morbidity.Death is rare but has been reported in hypocalcemia patients.

Natural History

• The clinical presentation of hypocalcemia vary widely, ranges from asymptomatic symptoms to life-threatening complications.
• Parathyroid hormone (PTH), vitamin D, the calcium ions, and phosphate are the main regulators that influence the serum calcium levels.
• As the people age the calcium requirement also increases and risk for calcium deficiency also increases by age.
• Poor calcium intake,certain medications,dietary intolerance,hormonal changes and genetic factors may lead to hypocalcemia.

Complications

• Common complications of hypocalcemia include
  • Bone disease like
    • Osteoporosis,Complications from osteoporosis include
      • Fractures 
      • Disability
  • Cardiovascular collapse with Cardiac arrhythmia
  • Hypotension which is unresponsive to fluids and vasopressors,
  • Dysrhythmias
  • Laryngospasm
  • Seizures
  • Tetany
  • Basal ganglia calcification
  • Parkinsonism
  • Hemiballismus
  • Choreoathetosis

Prognosis

• Prognosis is generally good when hypocalcemia treated accordingly.
• The concentrations of ionized calcium on day 3 could be very useful for the prediction of mortality and disability in patients with moderate and severe traumatic brain injury (TBI).