Hypocalcemia -- Printable Tables

TITLE:	HYPOCALCEMIA
AUTHORS:	MARIO SKUGOR , MD -- Department of Endocrinology
	MIRA MILAS , MD -- Department of Endocrinology
PUBLISHED:	JUNE 16, 2004

Table 1:
Causes of Hypocalcemia
Decreased Entry of Calcium into the Circulation	Increased Loss of Calcium from the Circulation	Other Causes
Hypoparathyroidism (absence of PTH secretion) Postoperative Autoimmune (isolated or part of polygandular autoimmune syndrome) Congenital (mutations of CaSR, PTH, and parathyroid aplasia) Pseudohypoparathyroidism, types 1a and 1b, and type 2 Magnesium depletion Severe hypermagnesemia Deficiency of vitamin D	Hyperphosphatemia Renal failure Rhabdomyolysis Tumor lysis Phosphate administration Acute pancreatitis Hungry bone syndrome Chelation Citrate EDTA Lactate Foscarnet Widespread osteoblastic metastases Prostate cancer Breast cancer	Sepsis Fluoride administration Surgery Chemotherapy Cisplatin 5-fluorouracil Leucovorin
CaSR = calcium-sensing receptor; PTH = parathyroid hormone; EDTA = ethylenediaminetetraacetic acid

Table 2:
Clinical Manifestations of Hypocalcemia
Neuropsychiatric Symptoms Seizures (all types) Dementia (in adults), mental retardation (in children) Emotional problems (anxiety, depression) Extrapyramidal symptoms (parkinsonism is most common) Calcifications of basal ganglia (in long-standing disease) Papilledema Increased Neuromuscular Irritability Chvostek's sign Trousseau's sign Paresthesias in circumoral and acral areas (fingers, toes) Muscle stiffness, myalgias, and spasms Cardiovascular Symptoms Prolongation of QT interval Congestive heart failure Hypotension Autonomic Symptoms Biliary colic Bronchospasm Diaphoresis Other Symptoms Cataracts Dry coarse skin, dermatitis, hyperpigmentation, and eczema Steatorrhea Gastric achlorhydria

Table 3:
iPTH Findings In Hypocalcemic Disorders
Disease	iPTH Level
Hypoparathyroidism	Mostly reduced, occasionally normal
Pseudohypoparathyroidism	Elevated
Vitamin D abnormalities	Elevated
Hypomagnesemia	Low, normal, or high
Autosomal dominant hypocalcemia	Normal

Table 4:
Oral Calcium Preparations
Calcium Preparation	Calcium Content Per Pill	Pill Size
Calcium carbonate	250 mg	650 mg
Calcium gluconate	90 mg	1000 mg
Calcium citrate	200 mg	950 mg
Calcium lactate	60 mg	300 mg

Table 5:
Vitamin D Preparations
Vitamin D Preparation	Half-Life	Form of Therapy
1,25-Dihydroxycholecalciferol Rocaltrol Calcijex	2-6 h	Capsule 0.25, 0.5 µg Injection 1 µg/mL 2 µg/mL
25-hydroxycholecalciferol Calderol (requires activation in the kidneys) Ergocalciferol (Vitamin D₂) Calciferol Drisdol	12-22 d Long (months)	Capsule 20, 50 µg Capsule 1.25 mg-50000 IU Solution 12.5 mg/mL Drops 200 µg/mL-8000 IU
Cholecalciferol (Vitamin D₃) Delta-D	Long (months)	Tablet 400, 1000 IU

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