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hypocalcaemia (clinical features (ECG (prolonged QT and st segment,…
hypocalcaemia
clinical features
seizures
involuntary muscle spasm
chvosteks and trousseaus sign
perioral tingling
abdo pain
ECG
prolonged QT and st segment
arrythmias torsades
roles of calcium
hypocalcaemia causes disturbances in the cell membrane
sodium channels are unstable and the cells depolarise easily
overall cell is more excitable
Causes
Too much leaving the blood
Kidney failure
kidneys leach calcium
tissue injury
burns, rhabdo, tumour lysis (increases phosphate)
Inflammatory processes
Pancreatitis: ca binding to free fatty acids
Blood transfusions: EDTA, Citrate both chelate calcium
remember to rule out
low albumin
less calcium binding yet same free ionised
alkalosis
more calcium binding to albumin and less free ionised calcium
not enough entering the blood
PTH- hypofunction
Surgery, autoimmune, Di-George syndrome, Mg defx, Phosphate.
Low vitamin D
Skin, GIT/ diet, kidney, liver
malabsorption
coeliac disease and decreased ca and phenytoin
Drugs
Phenytoin increased vitamin D metabolism and decrease ca absorption
Bisphosphonates (usually with hypoparathyroid)
Treatment
Calcium and vitamin D
Investigations
PTH, albumin, Mg, phosphorus, creatinine, vitamin D