Hypo/Hypercalcemia

Role of Calcium

Calcium plays a crucial role in neuromuscular signaling, cardiac contractility, and hormone secretion.

Extracellular Calcium Regulation

Extracellular calcium concentrations are maintained by parathyroid hormone and the Vitamin D metabolite 1,25-dihydroxyvitamin.

Hypercalcemia

Hypercalcemia can lead to clinical manifestations such as decreased renal concentrating ability, bone pain, ECG changes, and excessive PTH production.

Mild Hypercalcemia

Mild hypercalcemia is usually asymptomatic but can present with vague neuropsychiatric symptoms and other issues like peptic ulcer disease or nephrolithiasis.

Severe Hypercalcemia

Severe hypercalcemia can cause lethargy, stupor, coma, gastrointestinal symptoms, and is commonly associated with primary hyperparathyroidism.

Diagnostic Evaluation of Calcium Disorders

The first step in diagnosing hyper/hypocalcemia is to rule out abnormal albumin concentrations, followed by evaluating PTH levels.

Management of Hypercalcemia

Initial therapy for significant hypercalcemia includes volume expansion, loop diuretics, calcitonin, bisphosphonates, and other medications depending on the cause.

Hypocalcemia Etiologies

Hypocalcemia can result from impaired PTH or Vitamin D production, hypoparathyroidism, magnesium deficiency, or tissue injuries like burns or pancreatitis.

Clinical Manifestations of Hypocalcemia

Hypocalcemia can lead to symptoms like paresthesias, Chvostek's and Trousseau's signs, seizures, carpopedal spasm, and bronchospasm.

Diagnostic Approach for Calcium Disorders

Diagnosing hypercalcemia involves measuring calcium, albumin, phosphorus, and magnesium levels, along with determining PTH levels for hypocalcemia evaluation.

Management of Hypocalcemia

Acute symptomatic hypocalcemia is treated with calcium gluconate, while chronic hypocalcemia due to hypoparathyroidism may require calcium supplements and vitamin D.