What is Hypocalcemia?
If the calcium level in the blood is less than 8.5 mg/dl, it is called hypocalcemia.
There are many different causes of hypocalcemia. Finding the underlying cause is very important for treatment.
What Are the Symptoms ?
There are several manifestations of hypocalcemia. Since the decrease in the calcium level causes the nerve cells to be stimulated more quickly, muscle contractions are seen, which is an important finding specific to hypocalcemia.
- Symptoms of muscle contraction can be mild or severe. It may be accompanied by extreme fatigue.
- Numbness-pins and muscle cramps can be seen around the mouth, hands and feet. In its heavy form, it affects the larynx and creates a stenosis there, making it difficult to breathe and can cause death.
- Increase in seizures in those who have had seizures
- Chvostek sign; When the facial nerve is struck, retractions may be seen in the corner of the mouth.
- Trousseau’s sign; The appearance of a midwife’s hand is when the cuff of the sphygmomanometer is inflated above the systolic pressure. In the midwife’s hand, inward bending of the wrists is observed.
What are the Causes of Hypocalcemia?
As hypocalcemia causes various diseases, there are various conditions that cause hypocalcemia.
The most common cause is hypocalcemia, which develops due to the decrease of parathyroid hormone after undergoing thyroid surgery.
- Low magnesium
- Low albumin
- Kidney failure
- Vitamin D deficiency
- Rickets is a disease related to poor quality bone formation seen in children due to vitamin D deficiency.
- Tumor Lysis Syndrome
- HIV infection
Diagnosing hypocalcemia is quite simple. A calcium value of less than 8.5 mg/dl in the blood sample taken from the patient indicates that the patient has hypocalcemia. However, when faced with such a situation, the first thing to do is to control the albumin level in the blood.
Since calcium can be transported with albumin, in case of a possible low albumin, although the calcium level is normal, blood values may be low. In the treatment, the albumin deficiency is closed and the measurement is made again.
In the treatment of hypocalcemia; Calcium Gluconate treatment is given in cases such as severe contraction, loss of consciousness, prolongation of the QT interval in EKG, deterioration of heart rhythm or in cases where the calcium level suddenly drops. Calcium gluconate is an intravenous drug. When administering calcium gluconate, it is important to give it slowly.
In cases where clinical symptoms do not improve or there is no change in calcium level despite calcium gluconate treatment, magnesium is given.
Oral calcium salts are given if hypocalcemia is present for a long time or if the calcium level is more than 7.5 mg/dl. Calcium carbonate, lactate or 2-3 grams of gluconate treatment per day is given. In addition, vitamin D is added to the treatment. Although there is no serious calcium deficiency, calcium salts and vitamin D treatment are applied even if no symptoms are observed in the patients.
After the general condition improves, the causes of hypocalcemia are investigated. After the main cause is found, treatment is arranged for it. If there is hypocalcemia due to parathyroid hormone deficiency, oral calcium treatment is given together with Vitamin D3 or calcitriol.
The treatment is similar in hypocalcemia due to chronic renal failure. In this case, calcitriol is preferred for treatment.
If Hypocalcemia Is Untreated
Calcium is a very important ion especially for bones. If left untreated, osteoporosis, known as osteoporosis, may occur. Injury, easily broken bones and difficulties in walking can be faced with.
Calcium deficiency also has effects on the heart. These effects can be fatal. Hypocalcemia, which causes QT prolongation in EKG, can cause various rhythm disturbances. Diseases seen in calcium deficiency can result in death. That’s why calcium treatment, which seems simple, is vitally important.
What Is Good For Hypocalcemia?
The causes of calcium deficiency are quite numerous. The most important thing is to prevent the occurrence of these causes. The body should not be deficient in vitamin D, so sunbathing at an appropriate level provides calcium production for our body.
At the same time, consumption of milk and dairy products is very important for the calcium balance in our body. Therefore, among the recommendations for calcium deficiency is the consumption of milk and dairy products. However, since the cholesterol level in dairy products is high, it is necessary to be careful when consuming.
Foods such as sardines, salmon, orange juice, and dried beans are very rich in calcium. Quitting smoking and decreasing alcohol consumption have a special importance in terms of calcium balance in the body.
What Is Not Good For Hypocalcemia?
One of the important roles of vitamin D in our body is its role in calcium metabolism.
In a body deficient in vitamin D, calcium cannot be produced adequately. Therefore, not spending enough time in the sun prepares the ground for hypocalcemia.
A diet low in calcium-rich foods such as fish, eggs, and dairy products is one of the most important causes of hypocalcemia. Therefore, although our diet is balanced, it is necessary to consume these foods regularly.
Sudden weight loss, smoking and excessive alcohol consumption also prepare the ground for hypocalcemia. Therefore, it is the most appropriate method to lose weight properly by eating regularly. Smoking should be stopped to prevent all diseases.
Calcium gluconate is used in the treatment of hypocalcemia. This drug is an intravenous drug. In patients who do not respond to calcium gluconate, magnesium therapy is administered.
If there is a persistent low calcium level or if there is a low calcium level without any symptoms, oral calcium salts and vitamin D are used.
Additional attention should be paid to the use of medications. After all, calcium can be easily taken from outside. Drug treatment will not give the desired response unless there is a balanced diet.
There is no surgery specific to hypocalcemia. Treatment of the underlying disease is important in this process. If the cause of hypocalcemia is a kidney tumor, the kidney tumor should be surgically removed and hypocalcemia should be treated. Otherwise, there is no surgical correction of hypocalcemia.
Hypocalcemia During Pregnancy
During pregnancy, approximately 30 grams of calcium passes from mother to baby, and most of this happens in the last 3 months of pregnancy. Due to the decrease in albumin number during pregnancy and because calcium is transported via albumin, the total calcium number decreases.
Although the total calcium number decreases, the ionized calcium number does not change. Therefore, while the upper value of calcium in pregnancy is 9.5 mg/dl, its lower value is 8.1 mg/dl.
There is an increase in the production of vitamin D3 in the gestational sac and kidney, and therefore the absorption of calcium from the intestines increases. Increased calcium absorption causes a decrease in the parathyroid hormone level in the pregnant woman.
While these events are taking place, there is an increase in urinary calcium excretion. The condition of both increased absorption of calcium and increased excretion of calcium is defined as “absorptive hypercalciuria”. This is an expected situation.
Because, thanks to this mechanism, the calcium requirement of the baby in the mother’s womb is provided.
Causes of Hypocalcemia in Pregnancy
- Low albumin
- Decreased parathyroid hormone
- Magnesium sulfate treatment
- Magnesium metabolism disorders
- Vitamin D deficiency
- Blood transfusion to the pregnant
What Causes Calcium Deficiency During Pregnancy?
Parathyroid hormone decreases in the first 3 months of pregnancy. Due to the decrease in parathyroid hormone in the first 3 months of pregnancy, the level of calcium in the blood may decrease. However, during the rest of pregnancy, parathyroid hormone increases.
The increased parathyroid hormone increases the calcium level by affecting the bones and kidneys. This is a normal situation.
However, severe hypocalcemia due to a decrease in the number of parathyroid hormone during pregnancy is very rare. It should be treated as it can lead to undesirable consequences during pregnancy.
In the case of Hyperemesis Gravidarum, the disease associated with excessive nausea-vomiting in pregnant women, hypocalcemia may occur. Severe weight loss due to nausea and vomiting and loss of minerals in the body through vomiting cause hypocalcemia.
Calcium Deficiency Treatment During Pregnancy
The treatment algorithm is the same as for non-pregnant patients. In cases with severe symptoms or sudden and severe low calcium levels, calcium gluconate is given intravenously.
In cases that do not respond to treatment, magnesium therapy is applied.
Hypocalcemia in Children
A blood calcium level of less than 8.5 mg/dL is diagnosed in children. Causes of hypocalcemia in children include a diet low in vitamin D, lack of sun exposure, and a disease called rickets associated with vitamin D deficiency.
At the same time, conditions such as congenital hypoparathyroidism, frequent use of phosphate-containing enemas, kidney failure, chronic liver disease and magnesium deficiency are among the causes of hypocalcemia in children.
While the first symptoms of hypocalcemia are numbness in the hands and feet, as in adults, in the following periods;
- Skin dryness,
- Increase in brittle nails,
- Delay in the appearance of teeth,
- May occur as short stature and frequent infections.
In the initial treatment of the disease, intravenous calcium gluconate is used.
When the calcium value returns to normal, the underlying cause is investigated in detail. And treatment is given according to the underlying cause.
Hypocalcemia in Infants
A value below 7.5 mg/dl in newborn mature infants is considered hypocalcemia. Values below 7 mg/dl are considered hypocalcemia in premature babies.
Symptoms of hypocalcemia in newborns are not specific to hypocalcemia. It can also be seen in many diseases.
- Increased muscle tone
- Paleness of the body skin
- Sucking difficulty
- High-pitched crying
- Breathlessness attacks are the most common symptoms.
Hypocalcemia in newborns is divided into two as early and late.
The most common cause of early hypocalcemia is a congenital and temporary temporary deficiency of parathyroid hormone. These symptoms, which appear in the first 3 days of life, are more common especially in preterm births, in children of pregnant women with vitamin D deficiency, in babies with low sugar and in babies with respiratory distress.
In late hypocalcemia, the symptoms are usually 5-10. occurs between days. Cow’s milk is the most common cause. The reason why cow’s milk is to blame is its low Calcium / Phosphorus content.
Causes of Hypocalcemia in the Newborn
The causes of hypocalcemia in newborns are also quite numerous. Among these reasons, the most common ones are premature birth and mother’s diabetes.
- Lack of oxygen during birth
- Being pregnant from a mother who has high blood pressure and protein in her urine during pregnancy
- Application of radiation therapy to the baby
- Drinking cow’s milk
- Vitamin D deficiency
- Magnesium deficiency
- Vitamin D deficiency in the mother
- DiGeorge Syndrome
- Intrauterine growth retardation (IUGR)
Treatment of Hypocalcemia in the Newborn
The first treatment of unconscious newborn is the intravenous administration of 10% Calcium Gluconate solution as 2 ml per kilogram.
In late hypocalcemia, the aim is to lower the phosphate level in the blood. Breastfeeding is the most appropriate situation.
Adding calcium to the food lowers the phosphate level, so it tries to bring the calcium/phosphate ratio to an average of 4.