Hypocalcemia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents for ‍newknown hypocalcemia



Lab results:

Ca ‍ ‍low

Phosphate ‍ ‍normalhigh

Albumin ‍ ‍normal

Magnesium ‍ ‍normallow

Creatinine ‍ ‍normal

PTH ‍ ‍normallowhigh

Vitamin D ‍ ‍normallow



Associated symptoms: *Try using right-click for negatives*

‍none

‍muscle cramps

‍tetany

‍paresthesia

‍fatigue

‍weakness

‍seizures

‍dry skin

‍brittle nails

‍hair loss

‍depression

‍memory problems

‍confusion



Contributing factors:

‍low-calcium diet

no history of: ‍vitamin D deficiency, ‍hypoparathyroidism, ‍malabsorption syndromes, ‍chronic kidney disease, ‍pancreatitis, ‍malignancy

no use of: ‍calcium chelators, ‍bisphosphonates, ‍anticonvulsants, ‍proton pump inhibitors, ‍new medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Hypocalcemia ‍likelysuspectedpossible

DDx: primary hypoparathyroidism, secondary hypoparathyroidism, vitamin D deficiency, pseudohypoparathyroidism, hungry bone syndrome following parathyroid or thyroid surgery, acute pancreatitis, chronic kidney disease, medication-induced hypocalcemia (e.g., bisphosphonates, cinacalcet, antiepileptic drugs), magnesium deficiency, severe illness, massive blood transfusions, osteoblastic metastases, rhabdomyolysis, tumor lysis syndrome, alkalosis, chronic liver disease, malabsorption syndromes, celiac disease, inadequate dietary intake, alcoholism, sepsis, diGeorge syndrome (22q11.2 deletion syndrome), hypomagnesemia-induced hypocalcemia, loop diuretic use





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍calcium, ‍phosphate, ‍magnesium, ‍albumin, ‍PTH, ‍vitamin D, ‍vitamin D metabolites, ‍24-hour urine calcium

- ECG

- Bone density test

Treatments:

- ‍Calcium supplements

- ‍Vitamin D supplements

- ‍Alendronate

- ‍Risedronate

- ‍Zoledronic acid

- ‍Teriparatide

- ‍Denosumab

- ‍Calcimimetics

- ‍Phosphate binders

- Dietary counseling: increase intake of calcium-rich foods, vitamin D-rich foods, and foods low in phosphorus

- Weight-bearing exercises

- Smoking cessation counseling

- Alcohol moderation counseling

Further care:

- Referral to endocrinologist

- Referral to dietitian

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as muscle cramps, seizures, or changes in mental status