Calcium deficiency. Causes, symptoms and treatment

Signs and symptoms[edit]

Purpura

The neuromuscular symptoms of hypocalcemia are caused by a positive bathmotropic effect (i.e., increased reactivity) due to decreased calcium interaction with sodium channels. Because calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers, decreased calcium levels lower the threshold for depolarization. [7] Symptoms may be recalled by the mnemonic phrase “Cats go numb”—convulsions, arrhythmia, tetany, numbness in the arms and legs and around the mouth. [ citation needed

]

• Petechiae, which appear as on-off points, then coalesce and appear as purpura (larger bruised areas, usually in dependent areas of the body). [ citation needed
  ]
• Oral, perioral, and acral paresthesias, a tingling or pins-and-needles sensation in and around the mouth and lips, and in the extremities of the arms and legs. This is often the earliest symptom of hypocalcemia.
• Carpopedal and generalized tetany (unrelented and strong contractions of the hands and large muscles of the rest of the body) are observed.
• Latent tetany Trousseau's sign of latent tetany (causing wrist spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
• Chvostek's sign (tapping the lower cheekbone causes facial spasms) [8]

Reasons [edit]

Hypoparathyroidism is a common cause of hypocalcemia. [9] Calcium is strictly regulated by parathyroid hormone (PTH). In response to low calcium levels, PTH levels increase, and conversely, when calcium levels are high, PTH secretion decreases. [10] However, in the absence, decrease or ineffectiveness of the PTH hormone, the body loses this regulatory function, and hypocalcemia occurs. Hypoparathyroidism usually occurs due to surgical destruction of the parathyroid glands. [9] Hypoparathyroidism can also be caused by an autoimmune problem. [11] [12] Some causes of hypocalcemia are: [ citation needed

]

• Hyperphosphatemia [13]
• Vitamin D deficiency
• Chronic liver disease
• Edetate disodium [13]
• Magnesium deficiency [14]
• Long-term use of medications/laxatives (magnesium) [15]
• Osteomalacia [14]
• Chronic renal failure [15]
• Ineffective active vitamin D [15]
• Hypoparathyroidism/genetic [15]
• Postoperative hypoparathyroidism [15]
• Hungry bone syndrome
• Tumor lysis syndrome [16]
• Acute kidney injury [15]
• Rhabdomyolysis (initial stage) [14]
• As a complication of pancreatitis [14]
• Alkalosis [13]
• Excessive red blood cell transfusion due to excess citrate in the blood
• As the concentration of hydrogen ions in the blood plasma decreases, caused by respiratory or metabolic alkalosis, the concentration of freely ionized calcium, the biologically active component of blood calcium, decreases. Because a portion of the hydrogen and calcium ions are bound to serum albumin, when the blood becomes alkaline, the bound hydrogen ions dissociate from the albumin, freeing the albumin to bind to more calcium and thereby reducing the free ionized portion of total serum calcium. For every 0.1 increase in pH, ionized calcium decreases by approximately 0.05 mmol/L. This hypocalcemia associated with alkalosis is partly responsible for the cerebral vasoconstriction that causes dizziness, syncope, and the paresthesia often seen with hyperventilation.
• Neonatal hypocalcemia [17]
• Increased functional calcium-sensing receptor mutations
• Use of Foscarnet
• Use of loop diuretics
• Crohn's disease
• High levels of lactic acid in the blood
• Pseudohypoparathyroidism

Publications in the media

Hypocalcemia - serum calcium concentration below 8.5 mg%. Daily requirement: adults - 1,000–1,200 mg; children over 10 years old - 1,200–1,300 mg; children aged 3-10 years - 1,300-1,400 mg, young children - 1,300-1,500 mg. Products containing calcium - milk, cheese, cottage cheese, onions, spinach, cabbage, parsley.

Etiology • Hypoparathyroidism • Hypoalbuminemia leads to a decrease in the concentration of the protein-bound form. However, the serum Ca2+ content does not change, and there are no clinical manifestations of calcium deficiency. This condition is not considered true hypocalcemia • Pseudohypoparathyroidism is an inherited disease characterized by target organ resistance to PTH. There are 2 types of clinical manifestations •• Clinic caused by hypocalcemia and hyperphosphatemia •• Albright's disease • Renal failure leads to impaired hydroxylation of vitamin D and decreased resorption of calcium and phosphorus salts • Malabsorption syndrome leads to impaired calcium absorption • Vitamin D deficiency or resistance to its action • Damage to the pancreas due to its inflammation and a specific process can lead to the deposition of calcium salts in areas of fat necrosis • Metastasis of solid tumors leads to the deposition of calcium salts into the bone • Hypomagnesemia reduces the production and inhibits the action of PTH.

Clinical picture

• Latent tetany (mild hypocalcemia) •• Muscle fatigue, weakness, twitching of individual muscle groups, numbness and tingling around the mouth, hands and feet •• Positive Chvostek’s sign, but it is also observed in 10% of healthy individuals •• Positive Trousseau’s sign • • Positive Lyust sign.

• Obvious tetany (severe hypocalcemia) •• Muscle hypertonicity before the development of cramps •• Spasm of smooth muscles (laryngospasm) • Long-term effects of hypocalcemia •• Atrophy, fragility of the nail plates; dryness and flaking of the skin; enamel defects and dental hypoplasia •• Calcification of the basal ganglia, in some cases in combination with signs of parkinsonism •• Calcification of the lens often leads to cataracts.

Treatment is etiotropic and pathogenetic • Calcium preparations: for acute hypocalcemia - 10 ml of 10% calcium gluconate solution intravenously for 15–30 minutes, followed by repeating the injection and/or intravenous infusion of 20–30 ml in 1 liter of 5% solution -ra dextrose for 12–24 hours; for chronic hypocalcemia - 1-2 g/day of calcium orally, for example calcium gluconate (in 1 g - 90 mg of calcium) or calcium carbonate (in 1 g - 400 mg of calcium) in combination with ergocalciferol • Magnesium and potassium preparations - potassium and magnesium aspartate • Enzyme preparations for malabsorption syndromes • Administration of albumin intravenously for hypoalbuminemia • Ergocalciferol • To bind phosphates in the gastrointestinal tract - algedrate.

Age characteristics • Early childhood. In young children (6–18 months), latent and overt tetany, pathogenetically associated with rickets, is designated by the term spasmophilia •• Latent tetany. In children, in addition to the listed symptoms of mild hypocalcemia, respiratory arrhythmia is also noted, caused by hypertonicity of the accessory respiratory muscles and diaphragm against the background of physiological sympathicotonia •• Overt tetany. There are 3 leading syndromes. The presence of one syndrome or a combination of them is possible ••• Laryngospasm is a sudden narrowing of the glottis. In the clinic - pallor, difficulty breathing, possible apnea attack. A few seconds after a noisy inhalation, breathing is restored. ••• Carpopedal spasm is a tonic contraction of the muscles of the hands and feet. In the clinic - the limbs are bent at the large joints, the shoulders are pressed to the body, the hand is in the “obstetrician’s hand” position; the foot is in a state of plantar flexion. The duration of the spasm is variable - from a few seconds to several hours or days. Possible combination with hypertonicity of other muscle groups ••• Eclampsia - an attack of clonicotonic convulsions, covering all voluntary and involuntary muscles against the background of loss of consciousness. Very dangerous due to possible cardiac and respiratory arrest •• Treatment - calcium supplements, anticonvulsant therapy, ergocalciferol • Newborns - hypocalcemia of newborns •• Early hypocalcemia (serum Ca2+ content below 7 mg%, or 0.07 g/l) manifests itself in first 24–48 hours of life; usually associated with prematurity ••• Cause - functional insufficiency of the parathyroid glands (impaired response of the glands to the normal decrease in serum calcium after birth) ••• Predisposing factors - fetal asphyxia during childbirth; Diabetes in the mother ••• Treatment - administration of calcium preparations orally or intravenously in combination with anticonvulsants (for convulsive syndrome) •• Late hypocalcemic tetany can occur in the first few weeks of an infant's life ••• Cause - hyperphosphatemia (usually of nutritional origin ) ••• Treatment - calcium supplements.

ICD-10 • P71 Transient neonatal disorders of calcium and magnesium metabolism • E58 Nutritional calcium deficiency • E83.5 Disorders of calcium metabolism • M11.1 Hereditary chondrocalcinosis • M11.2 Other chondrocalcinosis

Mechanism[edit]

Physiologically, calcium in the blood is strictly regulated within a narrow range for proper cellular processes. Calcium in the blood exists in three main states: bound to proteins (mainly albumin), bound to anions such as phosphate and citrate, and as free (unbound) ionized calcium; all these forms are ionized. Only unbound calcium is physiologically active. Normal blood calcium levels range from 8.5 to 10.5 mg/dL (2.12 to 2.62 mmol/L), and unbound calcium levels range from 4.65 to 5.25 mg/dL (1 .16 to 1.31 mmol/l). [18]

Blood Ca levels

The daily intake of macronutrients depends on age and gender.

Adults:

• men and women under 65 years of age – 800–1000 mg;
• from 65 years – 1200 mg;
• lactating and pregnant women – 1500–2000 mg.

Children:

• up to 6 months – 400 mg;
• up to 3 years – 600 mg;
• from 3 to 10 years – 800 mg;
• from 10 to 14 years – 1000 mg;
• up to 18 years – 1200 mg.

Increased amounts of calcium are required by athletes and people engaged in heavy physical labor. Also, its consumption should be increased in the presence of injuries and bone fractures. The exact daily dose is determined by the attending physician.

Diagnosis[edit]

ECG of a person with hypocalcemia

Since a significant portion of calcium is bound to albumin, any change in albumin levels will affect the measured calcium level. Corrected calcium level based on albumin level: Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 * (4.0 - serum albumin [g/dL]). [19] Since calcium is also bound to small anions, it may be more useful to correct total calcium for both albumin and anion gap. [20]

Management [edit]

Management of this condition includes: [ citation needed

]

• Calcium gluconate 10% may be given intravenously or, if hypocalcemia is severe, calcium chloride may be given instead. This is only appropriate if the hypocalcemia is acute and has occurred over a relatively short period of time. But if the hypocalcemia was severe and chronic, then this regimen can be fatal because a certain degree of acclimatization occurs. Neuromuscular irritability, electrical instability of the heart, and associated symptoms are not cured or alleviated by rapid administration of corrective doses of calcium, but rather are exacerbated. Such rapid administration of calcium would result in effective overcorrection—symptoms of hypercalcemia would follow.
• However, in either case, maintenance doses of calcium and vitamin D (often in the form of 1,25-(OH)2-D3, i.e. calcitriol) are often necessary to prevent further decline.

Where to get diagnosed and treated for hypocalcemia in Moscow

Make an appointment with an endocrinologist at the El.En clinic. The specialist will conduct an examination and prescribe the necessary diagnostic procedures. Tests can be carried out in the clinic; we have modern equipment for making a diagnosis. When making an appointment, you choose a convenient time.

The disease is treated through drug therapy; the patient is prescribed drugs that compensate for the lack of necessary substances - calcium, vitamin D, magnesium, etc.

At the first consultation you will receive answers to all questions regarding this pathology. Call us or leave a request on the website.

Links[edit]

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