- Discussion:
-
physical properties
-
state in body fluids
- physiologic roles of calcium are well established;
- abnormally low concentrations of Ca permit spontaneous discharges of both sensory & motor fibers in
peripheral nerves, leading to tetany;
- w/ elevated levels, nerve impulses are blocked, leading to coma;
- calcium is also necessary & important addition to cell membranes, giving strength to
these structures and regulating permeability;
- sudden death may occur when the ionized calcium falls below 2 mg/dL;
-
differential diagnosis:
- Lab Values:
- normal values: 8.50 - 10.50 mg/dl or 4.48 -
5.21 mg/dl (ionized);
- ionized calcium level below 3 mg/dL indicates need for supplemental calcium, even if
there are no clinical symptoms;
- Evaluation:
- note if patient is symptomatic;
- hypocalcemic pts who are not symptomatic do not require urgent correction with IV Ca;
- history of worsening paresthesias in her arms and legs and/or history of cramps in hands and facial muscles;
- physical examination revealed mild hyperreflexia;
- diarrhea is also sometimes seen;
-
Chvostek's sign:
- facial muscle spasm elicited by tapring facial nerve immediately
anterior to the earlobe and below the zygomatic arch;
-
Trousseau's sign:
- carpal spasm elicited by occluding arterial blood flow to forearm for 3-5 minutes;
- check albumin: Ca decrease 0.8 for ea 1 gm/dl decr of albumin;
-
dangerous meds:
-
digoxin;
- calcium will potentiate the action of digoxin;
- consider continuous EKG, if pt requires IV Ca;
-
EKG Changes
- Treatment: (
calcium supplements)
- if serum phosphate concentration is elevated in severe hypocalcemia, correction of hyperphosphatemia must be
carried out w/ IV
glucose &
insulin before calcium is given inorder to
avoid metastatic calcification;
-
severe symptomatic hypocalcemia:
- requires immediate treatment because of the danger of respiratory failure due to laryngospasm;
- if patient's PO4 is normal or low, then:
-
Ca Gluconate 10-20ml (1-2gm) of 10% solution IV
in 100ml of D5W over 5 to 30 min;
Serum and other calcium fractions in patients after severe musculoskeletal trauma.
