Basics of Calcium

Hypocalcemia

Hypercalcemia

• Familial hypocalciuric hypercalcemia (FHH)
• Hypocalcemia

<aside> ⛱️ Hypocalcemia is most often due to hypoparathyroidism or vitamin D deficiency (e.g., malabsorption, chronic kidney disease).

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<aside> 🤨 Suspect hypocalcemia in the postoperative thyroidectomy patient with new-onset paresthesias and muscle spasms or cramping.

• Signs of neuromuscular irritability (e.g., paresthesias, spasms and cramps) are the most characteristic features of hypocalcemia.

• Occurs due to acute/transient hypoparathyroidism → decreased calcium reabsorption by the kidneys & increased urinary calcium excretion </aside>

<aside> ⛱️ The typical laboratory findings of vitamin D deficiency are ↓ calcium, ↓ (or normal) phosphate, and ↑ PTH.

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<aside> ⚠️ IV calcium can trigger life threatening arrhythmias in patients on digoxin

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<aside> ➰ Loop diuretics Lose calcium. Discontinue them in hypocalcemia.

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<aside> 🧼 Hypercalcemia can cause pancreatitis. Hypocalcemia in patients with pancreatitis suggests pancreatic necrosis.

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<aside> 💡 The presentation of hypercalcemia includes stones (nephrolithiasis), bones (bone pain, arthralgias), thrones  (increased urinary frequency), groans (abdominal pain, nausea, vomiting), and psychiatric overtones (anxiety, depression, fatigue). Note that these are also the findings of vitamin D overdose!

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<aside> ➿ Thiazide diuretics enhance Tubular calcium upTake: Discontinue them in hypercalcemia. Loop diuretics Lose calcium: They may be used to treat fluid overload in patients with hypercalcemia.

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Calcium.pdf