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Hypocalcemia

  • Criteria

    • Ca < 8.5 or iCal < 2
  • Sx

    • hyperreflexia, weakness, AMS
  • Labs

    • BMP (Ca, PO4, Mg), Vit D, PTH, albumin, iCal
  • Tx

    • calcium gluconate tabs 1g PO q6h
    • if severe, give calcium gluconate IV 10mL of 10% soln over 10 min
    • Vit D (calcitrol) 0.2 ug bid
    • replete Mg if low
    • phosphate binders if PO4 high
  • Ddx

    • hypoparathyroidism (PTH < 29)
    • low Vitamin D (1,25 Vit D < 20, high PTH, low PO4)
      • malabsorption
        • gastrectomy, bypass
        • celiac disease
        • tropical sprue
        • pancreatitis, pancreatic insufficiency (PMH CF)
        • PBC
      • decreased synthesis
        • liver disease, cirrhosis (EtOH)
        • renal failure (Cr high, GFR < 25)
      • poor intake
        • purely breast-fed infants
        • poor diet, rickets, osteomalacia
    • other
      • hypomagnesemia
      • hypoalbuminemia (albumin < 4)
      • ionized hypocalcemia (ionized Ca < 1.09)
      • hyperphosphatemia
      • Albright's hereditary osteodystrophy (child, high PTH, high PO4)

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