![]() ![]() Hypomagnesemia causes hypocalcemia by impairing parathyroid hormone secretion and renal resistance to parathyroid hormone, leading to decreased renal reabsorption of calcium. In severe hypocalcemia with seizures, laryngospasm, hypotension, or tetany, patients should receive emergent parenteral calcium gluconate to replenish calcium levels until severe and life-threatening abnormalities resolve. It is essential to check magnesium levels during calcium repletion as hypomagnesemia is a crucial cause of hypocalcemia. Hypocalcemia treatment initially focuses on symptomatic treatment rather than normalizing serum calcium. ![]() EKG abnormalities of hypocalcemia, such as QT prolongation, typically respond to IV calcium gluconate, returning the QT interval to baseline. On EKG, hypocalcemia presents with prolonged QT interval, but its significance is undetermined as it is rare for calcium derangements to be the etiology of cardiac arrest. Physical examination findings include hyperreflexia, carpopedal spasm, Trousseau sign, and Chvostek sign. Symptoms include circumoral paresthesias, muscle cramps, myalgias, dysphagia, depression, confusion, irritability, seizures, tetany, laryngospasm, and hypotension. ![]() Clinical manifestations of hypocalcemia depend on the severity of serum calcium levels and the rate of decline, with hypocalcemic crisis symptoms manifesting at an ionized calcium concentration of 2.8 mg/dL (0.7 mmol/L). The remaining 10% of calcium is complexed with anions to form calcium salts. Approximately 40% of circulating calcium is bound to protein (e.g., albumin), whereas about 50% of circulating calcium is in a physiologically active form. The majority of calcium in the body resides in bone, with only 1% of total body stores exchanged with extracellular fluid. ![]() Hypocalcemia occurs in 15 to 88% of hospitalized adult patients, depending on the measurement method (serum or ionized calcium). Calcium gluconate is a calcium salt used to directly replete serum calcium levels in cases of hypocalcemia through IV administration. ![]()
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