Hypocalcemia

A low calcium level in the blood indicates hypocalcemia, which is an electrolyte imbalance. Calcium levels in adults should be between 4.5 and 5.5 mEq/L. Calcium is required for strong bones and teeth, as well as proper muscle and nerve function. The parathyroid hormone (PTH), your kidneys, and your intestines keep your blood calcium levels at an optimum level. The action of PTH, in most cases, restores calcium levels to normal. On the other hand, hypocalcemia can occur when something lowers your blood calcium levels, and your body cannot respond appropriately to increase calcium levels in return effectively.

Hypocalcemia may be caused by:

• Calcium deficiency: Hypocalcemia can occur if you don't get enough calcium or have a condition that prevents your body from absorbing calcium.
• Vitamin D deficiency: Vitamin D helps maintain calcium levels in the body. Vitamin D deficiency causes your body's calcium absorption to decrease. This is more likely to occur if you are malnourished or do not get enough sun exposure.
• Chronic renal failure: Renal failure or kidney disease causes calcium levels in the blood to drop consistently.
• Magnesium deficiency: This occurs when your blood magnesium level is abnormally low. The Parathyroid hormones' (PTH) abilities are reduced when you have a low magnesium level in your body.
• Chronic liver disease
• Pancreatitis: It is due to the inflammation of the pancreas. According to new research, the body's preventive reactions against pancreatitis frequently result in hypocalcemia.
• Hypoparathyroidism: The parathyroid glands are found in the back of the neck, near the thyroid gland. Parathyroid hormone (PTH) is secreted by the parathyroid glands, which control calcium levels in the body. Hypocalcemia occurs when your body produces less PTH than it requires, causing you to have less calcium.
• Pseudohypoparathyroidism: This is a genetic condition in which your body cannot respond to PTH. As a result, your body produces too little calcium.
• Antiseizure medicines (e.g., phenytoin, phenobarbital) and rifampin and medications used to treat hypercalcemia. 
• Alcoholism  
• Hyperphosphataemia
• Certain medications such as diuretics, hormone replacement therapy, magnesium, and laxatives.
• Tumor lysis syndrome
• Osteomalacia
• Certain blood disorders
•  Bisphosphonate therapy

The most common signs of hypocalcemia are:

• Neuromuscular irritability (muscle spasm and twitching in hands, face, and feet)
• Muscle cramps
• Numbness and tingling
• Brittle nails
• Fatigue and weakness
• Confusion and anxiety
• Depression
• Memory loss
• Changes in hair texture
• Irregular heartbeat
• Scaly skin 

Your doctor may suspect hypocalcemia based on a variety of signs and symptoms by taking a complete medical history and inquiring about your recent symptoms. Muscle cramps, discomfort, and tingling in the fingers may prompt the doctor to suspect hypocalcemia.  A thorough examination is also an important element of the diagnosing process. Your healthcare provider may lightly tap you on the cheek in a certain area to check for involuntary facial muscle contractions, which is common in hypocalcemia.

Blood tests: A calcium blood test is required for a definitive diagnosis of hypocalcemia. Calcium is a common blood test often ordered as part of a basic metabolic panel (BMP) or a comprehensive metabolic panel (CMP).

A total calcium blood test is usually the initial step in determining calcium levels. This test determines the amount of calcium in the blood that is free and calcium that is bound to a common protein (called albumin). If the result of this test is low, you may need an albumin test. 

Additional blood tests might include the following:

• Complete blood count (CBC)
• Serum magnesium
• Serum creatinine
• Serum phosphate
• Alkaline phosphatase
• Vitamin D
• Parathyroid hormone
• Ionized calcium 

Hypocalcemia treatment varies depending on the underlying cause and severity. If a person's calcium level gets incredibly low, they will certainly require calcium via an intravenous (IV) line. This method can raise calcium levels faster than taking calcium orally. People who get IV calcium must be monitored closely in a hospital setting. Oral calcium supplements are usually sufficient for people who have a mild calcium deficiency. You may have to take these over a long period of time. 

Other important calcium-metabolizing substances, such as magnesium, may be required depending on the situation. You may also need to stop taking a medicine that is causing your calcium levels to drop too low. In some cases, you may need to start taking a new medicine (such as diuretics) to help you improve your calcium levels.

Depending on the conditions, additional treatments may be required. You may, for example, require therapy for an underlying disease such as renal or liver disease. Some people with hypoparathyroidism use a PTH replacement hormone to help them get their calcium levels back to normal.

If you've been diagnosed with hypocalcemia, you'll almost certainly need to be monitored again. This is to ensure that your calcium levels have returned to normal and that your treatment hasn't significantly boosted them. (This can lead to hypercalcemia, which has its own set of health problems.) Your healthcare provider will develop a treatment and monitoring plan tailored to your specific requirements.

The easiest way to prevent a calcium deficiency is to increase calcium intake in the diet. ( 2000-2500 mg per day depending on age and other factors ). Consult your doctor before using calcium supplements since taking in too much calcium, a condition known as hypercalcemia, can increase the risk of cardiovascular disease, kidney stones, and other major health concerns. 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 22, 2023.

References

Hypocalcemia - PMC (nih.gov)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279267/

Diagnosis and management of hypocalcemia | SpringerLink

https://link.springer.com/article/10.1007/s12020-020-02324-2