Hypocalcemia. Hypocalcemia: what it is, symptoms, treatment, causes, signs

Hypocalcemia

Hypocalcemia basically consists of calcium values in the body being below normal. Discover the most common symptoms, causes and what treatment helps in regulating it.

Calcium is an important mineral for our body. It becomes, in fact, the most abundant mineral we find in the human body, although those that contain it in greater quantities are both bones and teeth. However, did you know that calcium, blood, neurons, body tissues, and other fluids present in our body also contain calcium?

Among other important functions, it is fundamental for the development of strong bones and teeth, for adequate blood coagulation, for muscle relaxation and contraction, for sending and receiving various nerve signals, for the secretion of certain chemicals and hormones, and for normal heart rhythm.

We find calcium especially in dairy products (such as milk, yogurt, cheese and buttermilk) to be the best source. But there are other sources of calcium, such as green leafy vegetables (broccoli, cabbage, cabbage, bok choy and turnips), some fish (salmon and canned sardines), dried vegetables and nuts (sunflower seeds and nuts).

Symptoms and signs of hypercalcemia

Routine biochemical screening in patients without symptoms of hypercalcemia.
General symptoms: depression (30-40%), weakness (30%), fatigue and malaise.
Gastrointestinal symptoms: constipation, lack of appetite; vague abdominal symptoms (nausea, vomiting), weight loss.
Renal symptoms: kidney stones (with prolonged hypercalcemia); nephrogenic diabetes insipidus (20%); renal tubular acidosis type 1; prerenal renal failure; chronic hypercalcemic nephropathy, police polydipsia or dehydration.
Neuropsychiatric symptoms: agitation, depression, cognitive impairment; coma or stupor.
Cardiac symptoms: hypertension, arrhythmia.
Gastrointestinal symptoms: abdominal pain, nausea/vomiting, constipation, pancreatitis
Renal symptoms: polyuria (due to the diuretic effect of hypercalcemia and ADH-resistance of the kidneys) and associated polydipsia, impaired renal function, nephrolithiasis
Neurological symptoms: confusion, proximal muscle weakness and rapid muscle fatigue, weakened reflexes, fatigue, headaches, rarely ataxia, dysarthria and dysphagia, possible disturbances of consciousness up to coma
Psychiatric symptoms: depression, fear, stupor, psychosis
Cardiovascular symptoms: in the early phase, most likely hypertension, in the dynamics of hypotension (due to dehydration), heart rhythm disturbances, circulatory arrest
Other: bone pain, osteopenia with increased risk of fractures, weight loss, itching

With a rapid increase in calcium concentration, a hypercalcemic crisis may develop with exacerbation, confusion and disturbances of consciousness, and severe renal dysfunction.

Mild hypercalcemia is asymptomatic in many cases. At a serum Ca level of {amp}gt;12 mg%, emotional instability, confusion, and coma are possible. Hypercalcemia may be accompanied by neuromuscular symptoms, including skeletal muscle weakness. Hypercalciuria and nephrolithiasis often occur.

Calcium concentration {amp}gt;3.5 mmol/l.
Confusion or stupor.
Hypotension.
Severe dehydration leading to prerenal renal failure.

The acute form of hypocalcemia is a rather serious illness in which a syndrome of massive destruction of special cells - zukaryotes - occurs. This situation occurs with traumatic shock, burns, hemolysis, and the use of cytostatics. In this case, ionized calcium quickly leaves the blood. The patient's situation becomes even more complicated if cytolysis, the destruction of these cells, is combined with acute renal failure.

The chronic form of the syndrome is expressed by titania and increased neuromuscular excitability. Therefore, signs of hypocalcemia are expressed by paresthesia - numbness, tingling and goosebumps on the skin. In addition, laryngospasm (sudden contraction of the muscles of the larynx), bronchospasm (narrowing of the bronchi), and convulsions are observed.

Spasms also occur in the feet, hands, and facial muscles. Patients experience depression, psychosis, and short-term respiratory arrest often occurs.

Sometimes hypocalcemia manifests itself as hypocoagulation and hemorrhagic syndromes. In this case, increased bleeding occurs as a result of decreased blood clotting and the permeability of vessel walls due to a lack of calcium in the body.

Calcium deficiency leads to brittle hair and nails, heart rhythm disturbances and the development of cataracts, diseases of bones and teeth.

If hypocalcemia leads to disruption of brain activity, then the symptoms are expressed by memory loss, delirium, confusion, and hallucinations. If proper medical measures are taken quickly, these processes are reversible.

Initially, hypercalcemia is characterized by a latent course, in which the patient does not experience any painful sensations or the symptoms are so nonspecific that the patient cannot recognize the cause of their occurrence. At this stage, this disease should be classified as an incidental finding during a screening laboratory examination of the patient.

To a greater extent, patients suffering from hypercalcemia of varying severity complain of various dyspeptic disorders (nausea, lack of appetite, heartburn). During the period of a full-blown clinical picture, hypercalcemia is manifested by symptoms of intestinal obstruction (prolonged constipation, flatulence, spastic pain syndrome in the projection of the abdominal cavity without clear localization).

In a situation where a patient experiences hypercalcemia with a significant increase in calcium concentration in the body, severe clinical symptoms develop, which require urgent medical intervention. The patient becomes emotionally labile, and in an advanced stage, various degrees of impairment of consciousness are noted from somnobulence to coma.

Prolonged hypercalcemia is always accompanied by transient or chronic renal failure caused by the formation of many microcalcifications in the thickness of the renal parenchyma. It must be remembered that impaired urinary function of the kidneys provokes the development of persistent malignant hypertension in a patient with hypercalcemia, which in some cases is the only clinical manifestation of this disease.

If hypercalcemia occurs in the context of hyperparathyroidism, the patient has a tendency to develop peptic ulcers and signs of acute pancreatitis. Long-term severe hyperthyroidism is accompanied by the development of generalized fibrous osteodystrophy, which is characterized by an increase in the activity of osteoclasts and, as a consequence, the formation of areas of fibrous degeneration and cystic restructuring of bone tissue of various localizations.

The risk category for this pathology includes patients with renal failure who are on long-term dialysis, as well as patients with a secondary form of hyperparathyroidism. Laboratory confirmation of fibrous osteodystrophy is a significant increase in serum alkaline phosphatase.

Statistical data prove the possibility of death due to hypercalcemia. Death occurs with the development of shock and acute renal failure.

Impaired wakefulness, attention and concentration
Seizures
Paresthesia, tetany
Confusion, states of fear, agitation, hallucinations, depression
Chorea syndrome and Parkinson's syndrome in chronic hypocalcemia
AV block, circulatory arrest

To do this, apply a tonometer cuff as usual and compress the artery for 3 minutes. As a result, a characteristic spasm of the hand develops (Trousseau's symptom). Less reliably reveals a hidden tendency to convulsions. Chvostek's symptom - when you tap the area where the facial nerve exits with your finger, spasms of the facial muscles occur on the same side.

According to the results of the ECG, the Q-T interval may lengthen, which predisposes to the development of ventricular arrhythmia. Long-term hypocalcemia and hyperphosphatemia (eg, hypoparathyroidism) can cause cataracts, basal ganglia calcification, and epilepsy. Hypocalcemia and hypophosphatemia associated with vitamin D deficiency in adults cause osteomalacia.

Hypocalcemia is often asymptomatic. The main clinical manifestations of hypocalcemia itself are associated with changes in the membrane potential of cells, causing neuromuscular excitability.

Neurological manifestations. Spasms of the muscles of the back and legs often occur.

Tetany is typically associated with severe hypocalcemia, but also occurs with a decrease in only the ionized fraction of Ca in the absence of obvious hypocalcemia.

Tetany can be either obvious, manifested by spontaneous symptoms, or latent, which is detected only with the help of provocative manipulations. Latent tetany usually occurs with a smaller decrease in serum Ca concentration.

Other manifestations. Chronic hypocalcemia is also characterized by other manifestations: dry and flaky skin, brittle nails and coarse hair. Sometimes candidal infections develop (especially often with idiopathic hypoparathyroidism). With prolonged hypocalcemia, cataracts are also observed, and correction of the level of Ca in the serum does not lead to its reverse development.

What is hypocalcemia

We could define hypocalcemia as a disease in which calcium levels in the blood decrease below their normal values. That is, we are faced with an electrolyte imbalance consisting of the presence of low levels of calcium in the blood.

Calcium is considered normal in adults from 4.5 to 5.5 mEq/L or 8.5 to 10.2 mg/dL.

In case of low calcium levels in the blood, the doctor may evaluate the possibility of analyzing albumin values, so if this is also low, it is very important that the calcium level is corrected (which will be higher if the albumin is low).

Treatment

Treatment of hypocalcemia should begin as soon as test results are received. The treatment plan is developed by the attending physician, taking into account the general condition of the patient, as well as the severity of his disease:

diet therapy. The doctor is developing a special diet that will be enriched with calcium salts - up to 2000 mg per day;
the patient is recommended to spend as much time as possible in the sun, but not to sunbathe, but simply to take walks;
do not use sunscreen cosmetics, as they block ultraviolet radiation necessary for the full synthesis of vitamin D;
drug treatment is based on taking medications containing calcium and vitamin D;
It is also important to treat diseases that could trigger the progression of hypocalcemia.

In the case of acutely developing hypocalcemia, it is necessary to take urgent measures, since this condition threatens not only the health, but also the life of the patient:

It is indicated to carry out slow intravenous administration of sterile solutions of sodium chloride, glucose, calcium gluconate. This therapy is mandatory to reduce the manifestations of the disease, as well as the risk of complications;
if hypomagnesemia is observed against the background of acute hypocalcemia, it is indicated to inject magnesium sulfate into a vein.

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Diseases with similar symptoms:

Intoxication of the body - occurs due to prolonged exposure to various toxic substances on the human body. This could be industrial poisoning with poisons or chemical elements, prolonged use of medications, for example, in the treatment of oncology or tuberculosis. The influence of toxins can be both external and internal, produced by the body itself.

As is known, the respiratory function of the body is one of the main functions of the normal functioning of the body. A syndrome in which the balance of blood components is disturbed, or, to be more precise, the concentration of carbon dioxide greatly increases and the volume of oxygen decreases, is called “acute respiratory failure”; it can also become chronic. How does the patient feel in this case, what symptoms may bother him, what are the signs and causes of this syndrome - read below. Also from our article you will learn about diagnostic methods and the most modern methods of treating this disease.

Calcium is one of the vital macroelements. This mineral takes part in more than three hundred biologically important reactions.

In the human body, calcium ions take part in many processes (for example, blood clotting), and also regulate a variety of intracellular processes - muscle contraction, the release of hormones and other biologically active substances. Normally, the concentration of calcium in the blood is 2.25 – 2.75 mmol/l. Hypocalcemia is a pathological condition in which the level of calcium in the blood plasma is below 1.8 mmol/l.

Calcium deficiency can occur in children at any age. The risk of developing hypocalcemia is present in premature infants, children born in a state of asphyxia, as well as in children whose mothers have insulin-dependent diabetes mellitus.

Causes of hypocalcemia in a child

The most common cause of hypocalcemia in children is a lack of calcium, phosphorus and vitamin D in the diet. In addition, the cause of hypocalcemia in a child may be insufficiency of the parathyroid glands, magnesium deficiency, increased formation of the hormone thyrocalcitonin, and low levels of albumin protein in the blood. Hypocalcemia can also occur due to intestinal conditions in which the absorption of calcium by the mucous membrane of the small intestine is impaired (for example, malabsorption syndrome, removal of a section of the small intestine).

In addition, high levels of phosphate in the blood (hyperphosphatemia) can cause hypocalcemia. Hypocalcemia resulting from hyperphosphatemia usually occurs in children of the first year of life who receive cow's milk. This is because the phosphate content in cow's milk is too high for children of this age.

While the cause of the development of primary rickets is calcium deficiency, secondary rickets, which appears as a complication in a number of diseases, contributes to the occurrence of hypocalcemia. In children, secondary rickets is often observed with diseases of the liver, endocrine system, and taking certain medications (for example, anticonvulsants).

Symptoms of hypocalcemia

As a rule, hypocalcemia in children is manifested by a triad of symptoms - stridor, carpopedal syndrome and seizures. Carpopedal syndrome is a spasm of the hands, in which they take a characteristic position called the “obstetrician’s hand.” Stridor is noisy, wheezing breathing that occurs when air flows through a narrowed area of the airway. In children with hypocalcemia, carpopedal spasm is more common, and stridor and convulsive syndrome are observed much less frequently.

A dangerous condition that can occur in children with hypocalcemia is laryngospasm (spasm of the muscles of the larynx). The attack of laryngospasm is short-term, accompanied by noisy breathing, difficulty in breathing and temporary cessation of breathing. Also, calcium deficiency is characterized by the development of hypocoagulation and hemorrhagic syndromes, which are manifested by increased bleeding due to decreased blood clotting. In addition, symptoms of hypocalcemia may include heart rhythm disturbances, calf muscle spasms, increased brittleness of hair and nails, dryness and flaking of the skin.

Diagnosis and treatment

The clinical picture of hypocalcemia includes muscle spasms (biliary colic, abdominal pain, impaired swallowing, short choking breathing), tetany and atypical tetany (clumsiness in movements, cramps (sudden painful involuntary contraction of muscles), numbness), convulsions, laryngospasm, carpopedal spasm, prolongation of the QT interval on the electrocardiogram. In addition, with hypocalcemia, the child may experience prolonged diarrhea.

The presence of hypocalcemia can be determined based on laboratory data - a low concentration of calcium in the blood is characteristic - therefore, diagnosing this condition is not difficult.

In case of hypocalcemia, it is necessary to compensate for the calcium deficiency, as well as eliminate the cause that led to the development of this pathological condition. Hypocalcemia is usually treated with drugs containing calcium, vitamin D, and drugs that increase magnesium levels. Depending on the clinical situation, these drugs are used either in tablet form or as injections.

In order to avoid the development of hypocalcemia in a child, it is necessary to diversify the menu with foods rich in calcium, vitamin D, and magnesium. Considering the age of the child, it is recommended to include in his diet milk, fermented milk products, cheeses, eggs, sea fish, dried fruits (dried apricots, raisins), cereals (oatmeal, buckwheat), whole grain bread, vegetable oils, fresh vegetables and fruits, herbs. You should also ensure that your child gets enough sun exposure during safe hours, as the body produces vitamin D on its own.

Definition

is a low concentration of calcium in the blood serum. This condition is one of the electrolyte disorders. Hypocalcemia is much less common than hypercalcemia.

Almost all biochemistry laboratories routinely measure the concentration of total serum calcium, but the concentration of ionized calcium is biologically important.

What are the symptoms of hypocalcemia?

Because calcium is directly related to nerve and muscle function, one of the most common symptoms of hypocalcemia is the appearance of neuromuscular irritability, causing lesions or spasms. Consequently, it usually causes symptoms mainly at the level of bones, nerves and muscles.

But symptoms depend on the speed at which calcium levels in the blood decrease. So, for example, when hypocalcemia has been present for some time, there may be no symptoms, only minor signs such as a stinging or numbness in the fingers (the same thing happens when calcium values are a little low).

Muscle pain is common, and tingling sensations are also felt in the arms, legs and mouth.

In addition, these are also common symptoms such as shortness of breath and palpitations accompanied by irregular contractions, including confusion , hallucination and delirium , especially when the blood calcium value is very low.

Diagnostics

Diagnosis of hypocalcemia includes:

examination of the patient;
study of symptoms;
taking anamnesis;
laboratory research.

Patients with calcium deficiency may experience the following autonomic disorders:

insomnia;
dizziness;
numbness or tingling of the limbs, tongue and lips;
palpitations and shortness of breath;
feeling hot or cold;
stabbing and aching pain in the heart area;
convulsions;
poor memory;
sleep disorders;
pain in muscles, joints and bones;
vomit.

Convulsive syndrome is the earliest manifestation of calcium deficiency. At the initial stage of the disease, it does not pose a danger in itself, but it significantly affects the patient’s quality of life. In advanced cases, seizures can be similar to epilepsy, with temporary loss of consciousness and the development of hallucinations. And they can even provoke death.

Symptoms of hypocalcemia are similar to those of many other diseases, so laboratory diagnostics are necessary for an accurate diagnosis. It is performed by testing the blood to determine the level of total and free calcium.

In some cases the following may be prescribed:

blood chemistry;
radiography (for skeletal pathology);
densitometry (to determine bone density);
MRI of internal organs.

Since hypocalcemia does not have unambiguous symptoms characteristic only of it, it is most often detected by chance, during tests or a routine examination. And after diagnosing the pathology, the patient begins to develop symptoms that initially were not given much importance.

What are the causes of hypocalcemia

There are many reasons that can directly or indirectly affect the decrease in calcium levels in the blood. The most common are the presence of certain nutritional deficiencies, such as vitamin D or magnesium . Or unhealthy habits such as drinking alcohol .

This may be due to other more serious and serious causes, such as the presence of chronic kidney failure, certain types of blood disorders or leukemia, and tumor lysis syndrome (when chemotherapy quickly destroys tumor cells).

It can also be caused by other reasons, such as the consumption of certain medications (diuretics, estrogens, glucose, insulin, laxatives) or treatments such as bisphosphonates.

Main types of pathology

There are two forms of the disease: chronic and acute hypocalcemia. Symptoms of the latter are characterized by the appearance of massive cytolysis syndrome. In this case, ionized calcium is quickly removed from the blood. The pathology is characterized by rapid progression if cytolysis is also accompanied by renal failure.

There is another classification of the disease. Hypocalcemia occurs:

Functional (develops as a result of disruption of the internal organ systems).
Toxigenic (formed by the use of certain groups of medications, the influence of toxic substances).
Violation of the usual regulation of calcium-phosphorus-magnesium metabolism.

How to treat

Treatment depends on both the cause of hypocalcemia and the degree. For example, it depends on whether it is acute hypocalcemia, which appears quickly, if it is chronic, or if it is accompanied by low blood magnesium:

Acute hypocalcemia: consists of intravenous calcium administration.
Chronic hypocalcemia: Oral calcium and vitamin D supplementation.
Hypomagnesia: consists of the presence of low levels of magnesium in the blood. It is treated by administering magnesium intravenously.

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Prevention

To control tetany, it is necessary to completely eliminate alkalosis if arterial PC0 2 increases when inhaling exhaled air in a paper bag or when introducing 5% CO 2 into oxygen. In severe cases of alkalotic tetany, intravenous calcium gluconate often relieves spasm; at the same time, it is subject to specific treatment for alkalosis, which depends on its cause.

Normally, the concentration of calcium in human blood plasma is 2.2 – 2.5 mmol/l. When it decreases below 1.87 mmol/l, a pathological condition called hypocalcemia develops.