Common Symptoms and Treatment of Hypocalcemia

What is Hypocalcemia?

Hypocalcemia is a common abnormality marked by low calcium levels in the blood. Calcium is an essential mineral our body requires, especially during the growing years. It is responsible for strengthening bones, nerve and muscle coordination, helps blood clotting, strengthens the immune system, and regulates the normal functioning of hormones and enzymes in our body. The blood calcium levels should lie between 2.1 to 2.6 mmol/L. When the blood calcium level drops below 2.12 mmol/L, it causes Hypocalcemia.

The average calcium levels are attributed to 3 main calcium-regulating hormones; parathyroid hormone (PTH), vitamin D, and calcitonin. Any deficiency or insufficiency of these hormones creates calcium deficiency in the body.

Hypocalcemia can be acute or chronic and asymptomatic or severely symptomatic. It affects all age groups, and its severity depends on the underlying cause.

What are the symptoms of Hypocalcemia?

Hypocalcemia symptoms vary according to the severity of the condition. The most common signs of calcium deficiency include burning or prickling sensations in limbs, muscle spasms, cramps, uncontrolled movements, loss of sensation around the mouth, and seizures. 

Hypocalcemia also shows neuromuscular and neurological symptoms, cognitive impairment, personality disturbances, electrocardiographic changes, or heart failure.

Neuromuscular symptoms of Hypocalcemia include:

• Uncontrolled movement of facial muscles called Chvostek’s sign
• Uncontrolled movement of hand and wrist while recording blood pressure called Trousseau’s sign
• Uncontrolled muscle contraction of vocal cords called Laryngospasm
• Uncontrolled muscle contraction of bronchial tubes called Bronchospasm

Neurological symptoms of Hypocalcemia include:

• Personality disturbances
• Irritability
• Impaired intellectual ability
• Nonspecific changes in the electroencephalogram (EEG) of the brain
• Increased pressure inside the skull
• Parkinsonism
• Uncontrolled movements of limbs  

Cognitive symptoms of Hypocalcemia include:

• Confusion
• Disorientation
• Hallucinations
• Fatigue
• Anxiety
• Poor memory
• Reduced concentration

Calcium deficiency symptoms on the skin include:

• Dry skin
• Coarse hair
• Brittle nails
• Hair loss
• Thin enamel on teeth
• Shortened roots of teeth
• Delayed tooth eruption
• Increased dental caries
• Atopic eczema
• Psoriasis

Symptoms of Hypocalcemia on muscles include:

• Difficulty swallowing
• Abdominal pain
• Shortness of breath
• Wheezing

Symptoms of Hypocalcemia in the eye include:

• cataracts
• Swelling in optic nerve

Symptoms of Hypocalcemia in the heart include:

• Irregular heart rhythm during ECG
• heart failure
• Ineffective pumping of blood by the heart

What are the causes of Hypocalcemia?

The low levels of calcium in the blood are attributed to Hypoparathyroidism. It is the condition in which parathyroid glands in the neck secrete low levels of parathyroid hormone(PTH). Hypoparathyroidism can be due to autoimmune disease, genetics, surgical removal of parathyroid glands, or medications such as anticonvulsants that can interfere with the normal functioning of the parathyroid gland.

Other causes of Hypocalcemia include:

• Vitamin D inadequacy 
• The Vitamin D-dependent forms of rickets
• Lack of sunlight exposure
• Nutritional deficiency
• Kidney disease or end-stage liver disease causing vitamin D inadequacy
• Abnormal Magnesium levels
• Cancer in bones
• Acute pancreatitis
• Injecting phosphate into the body
• Blood transfusions containing citrate, an anticlotting chemical
• Critical illness
• Stress and anxiety
• The inability of the kidney to reabsorb from urine
• Radiation therapy of parathyroid glands

Who is at risk of Hypocalcemia?

• Those with a vitamin D deficiency are at high risk of Hypocalcemia. Other risk factors include:
• Malfunctioning of kidney
• A diet deficient in calcium and Vitamin D
• a history of gastrointestinal disorders
• pancreatitis
• Chronic liver disease
• Celiac disease
• Certain cancers
• anxiety disorders
• premature infants, infants of diabetic mothers, and infants who have suffered a lack of oxygen

How can Hypocalcemia be treated?

Hypocalcemia treatment depends on the underlying cause. The following treatments are recommended for Hypocalcemia:

1. Oral calcium 

Calcium carbonate and calcium citrate supplements have a high calcium concentration (40% and 28%, respectively) and are easily absorbed. Calcium supplements can be started at a dosage of 500 to 1000 mg 3 times daily and then increased to 1 to 2 g thrice a day.

2. Intravenous calcium

Calcium gluconate is injected when blood calcium levels fall below 1.9 mmol/L and when patients are symptomatic. It can cause cardiac arrhythmias, bradycardia, and low blood pressure. This injection should be given under medical supervision.

3. Vitamin D 

Vitamin D supplements such as ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) are recommended to increase Vitamin D levels. Vitamin D2 is given in doses of 50 000 IU weekly or twice weekly for three months, followed by a regular assessment.

Vitamin D analogues, specifically calcitriol or alfacalcidol, are used to treat Hypoparathyroidism.

4. Teriparatide 

Teriparatide is another medication used to increase parathyroid hormone. It is injected to increase calcium reabsorption from the kidneys and blood calcium levels.

5. Thiazide diuretics 

Thiazide diuretics help lower calcium excretion through urine by increasing calcium reabsorption in the kidney. This medication works best with a low-salt, low-phosphate diet.

6. Dietary recommendations for Hypocalcemia

Incorporating foods rich in calcium can improve calcium levels in the blood. Here is the list of foods that are high in calcium:

• Spinach
• dairy products 
• oranges
• almonds
• sesame seeds
• Soybean
• Ragi
• Amaranth
• Okra
• Green beans
• broccoli
• figs
• plant-based milk
• fortified cereals
• salmon
• prawns

The mineral calcium is essential for the basic functioning of the body. Low calcium levels can cause uncontrolled body movements, neurological dysfunction, skin problems, dental problems, poor memory, lethargy and heart failure.

Proper diagnosis and treatment can help restore normal calcium levels in the blood. Calcium and vitamin D-rich diets can help prevent Hypocalcemia.

Frequently Asked Questions?

Disclaimer: The information given in this article is true to our best knowledge. Still, we recommend you consult your doctor first before taking any medication or treatment for Hypocalcemia mentioned in this article.

References

• https://www.ncbi.nlm.nih.gov/books/NBK279022/