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: Vamsikrishna Gunnam M.B.B.S [2]

Overview

The clinical features of hypocalcemia may vary widely, and range from asymptomatic to life-threatening complications.The main factors that influence serum calcium levels are parathyroid hormone (PTH), vitamin D, ionized calcium, and phosphate. Hypocalcemia is commonly encountered in patients who are hospitalized. Under treatment 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 may vary widely and range from asymptomatic to life-threatening complications.^[1]
Parathyroid hormone (PTH), vitamin D, ionized calcium, and phosphate are the main regulators that influence serum calcium levels.^[2]^[3]^[4]
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^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]
- Bone disease such as:
  - Osteoporosis, complications from osteoporosis include
    - Fractures
    - Disability
- Cardiovascular collapse with cardiac arrhythmia
  - The ECG hallmark of hypocalcaemia is prolongation of the corrected QT interval.
- Hypocalcemic cardiomyopathy
- Hypotension which is unresponsive to fluids and vasopressors
- Dysrhythmias
- Laryngospasm
- Seizures
- Tetany
- Basal ganglia calcification
- Parkinsonism
- Hemiballismus
- Choreoathetosis
- Intradialytic hypotension

Prognosis

Prognosis is generally good when hypocalcemia treated optimally.
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).^[16]^[17]

References

↑ Kelly A, Levine MA (2013). "Hypocalcemia in the critically ill patient". J Intensive Care Med. 28 (3): 166–77. doi:10.1177/0885066611411543. PMID 21841146.
↑ Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.
↑ Lee S, Mannstadt M, Guo J, Kim SM, Yi HS, Khatri A, Dean T, Okazaki M, Gardella TJ, Jüppner H (October 2015). "A Homozygous [Cys25]PTH(1-84) Mutation That Impairs PTH/PTHrP Receptor Activation Defines a Novel Form of Hypoparathyroidism". J. Bone Miner. Res. 30 (10): 1803–13. doi:10.1002/jbmr.2532. PMC 4580526. PMID 25891861.
↑ Mizunashi K, Furukawa Y, Abe K, Yoshinaga K (December 1993). "The relationship between serum intact parathyroid hormone and calcium in idiopathic hypoparathyroidism". Calcif. Tissue Int. 53 (6): 378–83. PMID 8293350.
↑ Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.
↑ Garabédian M (June 1998). "[Hypocalcemia]". Rev Prat (in French). 48 (11): 1201–6. PMID 9781172.
↑ Reber PM, Heath H (January 1995). "Hypocalcemic emergencies". Med. Clin. North Am. 79 (1): 93–106. PMID 7808098.
↑ Macefield G, Burke D (February 1991). "Paraesthesiae and tetany induced by voluntary hyperventilation. Increased excitability of human cutaneous and motor axons". Brain. 114 ( Pt 1B): 527–40. PMID 2004255.
↑ Thurlow JS, Yuan CM (April 2016). "Dialysate-induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations". Hemodial Int. 20 (2): E8–E11. doi:10.1111/hdi.12386. PMID 26923551.
↑ Levine SN, Rheams CN (June 1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.
↑ Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B (August 1990). "Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement". Am. Heart J. 120 (2): 381–6. PMID 2382615.
↑ Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (April 1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.
↑ Denlinger JK, Nahrwold ML (1976). "Cardiac failure associated with hypocalcemia". Anesth. Analg. 55 (1): 34–6. PMID 942827.
↑ Brunelli SM, Sibbel S, Do TP, Cooper K, Bradbury BD (October 2015). "Facility Dialysate Calcium Practices and Clinical Outcomes Among Patients Receiving Hemodialysis: A Retrospective Observational Study". Am. J. Kidney Dis. 66 (4): 655–65. doi:10.1053/j.ajkd.2015.03.038. PMID 26015274.
↑ Gupta MM (October 1989). "Medical emergencies associated with disorders of calcium homeostasis". J Assoc Physicians India. 37 (10): 629–31. PMID 2632508.
↑ Manuel VR, Martin SA, Juan SR, Fernando MA, Frerk M, Thomas K, Christian H (2015). "Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury". Asian J Neurosurg. 10 (3): 190–4. doi:10.4103/1793-5482.161171. PMC 4553730. PMID 26396605.
↑ Vinas-Rios JM, Sanchez-Aguilar M, Sanchez-Rodriguez JJ, Gonzalez-Aguirre D, Heinen C, Meyer F, Kretschmer T (February 2014). "Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury". Neurol. Res. 36 (2): 102–6. doi:10.1179/1743132813Y.0000000272. PMID 24139087.

Template:WS Template:WH

[pmid21841146-1] Kelly A, Levine MA (2013). "Hypocalcemia in the critically ill patient". J Intensive Care Med. 28 (3): 166–77. doi:10.1177/0885066611411543. PMID 21841146.

[pmid231481472-2] Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.

[pmid25891861-3] Lee S, Mannstadt M, Guo J, Kim SM, Yi HS, Khatri A, Dean T, Okazaki M, Gardella TJ, Jüppner H (October 2015). "A Homozygous [Cys25]PTH(1-84) Mutation That Impairs PTH/PTHrP Receptor Activation Defines a Novel Form of Hypoparathyroidism". J. Bone Miner. Res. 30 (10): 1803–13. doi:10.1002/jbmr.2532. PMC 4580526. PMID 25891861.

[pmid8293350-4] Mizunashi K, Furukawa Y, Abe K, Yoshinaga K (December 1993). "The relationship between serum intact parathyroid hormone and calcium in idiopathic hypoparathyroidism". Calcif. Tissue Int. 53 (6): 378–83. PMID 8293350.

[pmid23148147-5] Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.

[pmid9781172-6] Garabédian M (June 1998). "[Hypocalcemia]". Rev Prat (in French). 48 (11): 1201–6. PMID 9781172.

[pmid7808098-7] Reber PM, Heath H (January 1995). "Hypocalcemic emergencies". Med. Clin. North Am. 79 (1): 93–106. PMID 7808098.

[pmid2004255-8] Macefield G, Burke D (February 1991). "Paraesthesiae and tetany induced by voluntary hyperventilation. Increased excitability of human cutaneous and motor axons". Brain. 114 ( Pt 1B): 527–40. PMID 2004255.

[pmid26923551-9] Thurlow JS, Yuan CM (April 2016). "Dialysate-induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations". Hemodial Int. 20 (2): E8–E11. doi:10.1111/hdi.12386. PMID 26923551.

[pmid4014262-10] Levine SN, Rheams CN (June 1985). "Hypocalcemic heart failure". Am. J. Med. 78 (6 Pt 1): 1033–5. PMID 4014262.

[pmid2382615-11] Wong CK, Lau CP, Cheng CH, Leung WH, Freedman B (August 1990). "Hypocalcemic myocardial dysfunction: short- and long-term improvement with calcium replacement". Am. Heart J. 120 (2): 381–6. PMID 2382615.

[pmid1633370-12] Kudoh C, Tanaka S, Marusaki S, Takahashi N, Miyazaki Y, Yoshioka N, Hayashi M, Shimamoto K, Kikuchi K, Iimura O (April 1992). "Hypocalcemic cardiomyopathy in a patient with idiopathic hypoparathyroidism". Intern. Med. 31 (4): 561–8. PMID 1633370.

[pmid942827-13] Denlinger JK, Nahrwold ML (1976). "Cardiac failure associated with hypocalcemia". Anesth. Analg. 55 (1): 34–6. PMID 942827.

[pmid26015274-14] Brunelli SM, Sibbel S, Do TP, Cooper K, Bradbury BD (October 2015). "Facility Dialysate Calcium Practices and Clinical Outcomes Among Patients Receiving Hemodialysis: A Retrospective Observational Study". Am. J. Kidney Dis. 66 (4): 655–65. doi:10.1053/j.ajkd.2015.03.038. PMID 26015274.

[pmid2632508-15] Gupta MM (October 1989). "Medical emergencies associated with disorders of calcium homeostasis". J Assoc Physicians India. 37 (10): 629–31. PMID 2632508.

[pmid26396605-16] Manuel VR, Martin SA, Juan SR, Fernando MA, Frerk M, Thomas K, Christian H (2015). "Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury". Asian J Neurosurg. 10 (3): 190–4. doi:10.4103/1793-5482.161171. PMC 4553730. PMID 26396605.

[pmid24139087-17] Vinas-Rios JM, Sanchez-Aguilar M, Sanchez-Rodriguez JJ, Gonzalez-Aguirre D, Heinen C, Meyer F, Kretschmer T (February 2014). "Hypocalcaemia as a prognostic factor of early mortality in moderate and severe traumatic brain injury". Neurol. Res. 36 (2): 102–6. doi:10.1179/1743132813Y.0000000272. PMID 24139087.

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