Hypocalcaemia
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What is Hypocalcaemia?

Hypocalcaemia is a condition in the body which occurs due to the deficiency of calcium. Calcium is a very important mineral in our body and is vital for the healthy bones and teeth. It is also essential for muscle contraction, regulation of the heart beat and in the formation of the blood clots. If the shortage of calcium is prolonged, it might lead to osteoporosis.

Calcium levels are controlled in our bodies by four pea-sized structures called parathyroid glands. These glands are located within the tissue of the thyroid gland and detect the fluctuation in the calcium levels in the blood. In case of calcium level drop, these secrete parathyroid hormone to combat the situation. In case the calcium levels rise too much, the secretion of this hormone stops and the calcium levels come to normal again.

Hypocalcaemia is caused when the body experiences chronic kidney failure, pancreatitis or problems with the parathyroid glands. When the calcium levels drop below 3.5 mmol/L or 9 mg/dl or in ionized form, when calcium level drops to less than 1.1 mmol/L (4.5 mg/dL), hypocalcaemia is diagnosed.

Calcium is usually bound to proteins in the blood; however it is the unbound calcium, which remains in the ionized form in the body that is regulated by the parathyroid glands. Since the count of plasma form of calcium might be inaccurate in case of abnormal protein levels, it is usually the ionized calcium count that is taken into account.

Symptoms of Hypocalcaemia

Calcium deficiency in the blood may lead to Tetany, that is muscular spasm, (Latent tetany, Trousseau sign of latent tetany) in the hands, feet or throat, carpopedal spasm, depression, numbness and tingling in the hands, feet or around the mouth, fits, Perioral tingling and parasthesia, Chvostek's sign (tapping of the inferior portion of the zygoma leading to facial spasms), hyperactive tendon reflexes etc. These are few of the common symptoms of hypocalcaemia.

Some of the more complicated life threatening situations which arise due to hypocalcaemia are -- Laryngospasm, Cardiac arrhythmias, EKG changes, Prolonged QTc, Prolonged ST interval.

Causes of Hypocalcaemia

Hypocalcaemia is usually caused by the malfunction or deficiency of the parathyroid hormone, Vitamin D deficiency, unusually high or low magnesium levels hypomagnesaemia / hypomagnesaemia, chronic kidney failure, pancreatitis or problems with the parathyroid glands. Other than these basic causes, few more causes are mentioned below, which result in the condition of hypocalcaemia. These causes are: prolonged use of medications/laxatives containing magnesium, absence of parathyroid hormone (PTH), hereditary hypoparathyroidism, acquired hypoparathyroidism, hypomagnesaemia, following parathyroidectomy, Hungry Bone Syndrome, following thyroidectomy, the parathyroid glands are located very close to the thyroid and can be easily injured or even accidentally removed during thyroidectomy, absent active vitamin D, decreased dietary intake, decreased sun exposure, defective Vitamin D metabolism, anticonvulsant therapy, Vitamin-D dependent rickets type I, ineffective active vitamin D, intestinal malabsorption, Vitamin-D dependent rickets type II, Pseudohypoparathyroidism, deficient PTH, severe acute hyperphosphatemia, tumor lysis syndrome, acute renal failure, Rhabdomyolysis (initial stage), Osteitis fibrosa following parathyroidectomy, exposure to hydrofluoric acid, as a complication of pancreatitis, as a result of hyperventilation, Chelation Therapy, neonatal hypocalcaemia, very low birth weight (less than 1500 grams) and gestational age of less than 32 weeks.

Treatment of Hypocalcaemia

Calcium levels can be increased in the blood by increasing the calcium intake or by adding calcium-rich food to your diet. Some of such calcium rich food products are -- dairy products, cheese, yoghurt, milk, canned fish, leafy green vegetables, fortified bread and cereals. Other than this, increasing the intake of Vitamin D and calcium by taking supplements is also required to prevent any further decline in the calcium levels, as Vitamin D helps in the absorption of calcium in the body. Vitamin D is found in foods like cod liver oil, mackerel, canned salmon, eggs and milk.

Medically, two ampoules of Calcium Gluconate (10%) are administered to the patient intravenously. In case the hypocalcaemia is extremely severe, calcium chloride is administered in place of calcium gluconate.

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