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Hypocalcaemia (Aetiology (Infection Sepsis, Iatrogenic Post surgical,…
Hypocalcaemia
Aetiology
Infection
Sepsis
Iatrogenic
Post surgical
Degenerative
Osteomalacia
Endocrine
Hypoparathyroidism
Metabolic
Hypomagnesemia
Low vitamin D
CKD
Rhabdomyolysis
Overhydration
Acute pancreatitis
Neoplastic
Bone cancer/mets
Diagnosis
Examination
Neuro exam
Spasm, tetany, weakness, seizures
Chovstek's sign - tap facial nerve, twitch +ve
Trosseau's sign - inflate BP cuff 3m, carnopedal spasm +ve
(flex wrist, MCP and thumb; ext PIP/DIP, adduct fingers)
Investigations
Bedside
Obs (low BP).
ECG - prolonged QT
Bloods
FBC (infection), CRP (infection) U+E, LFTs (Alb level), bone profile (high phos in CKD, hypopara, vit D deficiency, low Mg; low in pancreatitis, bone disease), Ca (low), Mg, vit D, PTH (may be low/high), CK (rhabdo)
History
DH
Meds, allergies
FH
Electrolyte/emtabolic disturbances
PMH
Known medical conditions
Previous surgeries
SH
Living arrangements, occupation,
smoking, alcohol
PC/HPC
Neurological signs (weakness, tetany, spasm,
cramps, peri-oral parasthesia, seizures,
recent infection, surgery
Clinical
presentation
Neurological
Peri-oral parasthesia
Weakness
Cramps
Spasm (carpopedal, laryngospasm)
Tetany
Confusion
Seizures
Cataracts
Management
Initial ABCDE
Definitive
Conservative
Information, advice, support
Identify and treat cause
Medical
Ca gluconate
Indication: severe hypo-Ca
Ca replacement
Indication: hypo-Ca
IV infusion if severe, then PO
Vit D replacement
Indication: low Vit D
PO if possible
Definition
Disorder of low Ca level