Hypocalcemia

Introduction:

Hypocalcemia is an abnormally low level of calcium in the blood. Decreased
levels of calcium may be due to inadequate intake or absorption (vitamin D defi-
ciency, malabsorption), excess loss (associated with burns, renal disease, diuretics,
or alcoholism), endocrine disorders (such as hypoparathyroidism), decreased serum
albumin, hyperphosphatemia, or sepsis.

PROGNOSIS
Identification and correction of the cause is necessary to return the patient to a nor-
mal fluid and electrolyte balance. As the calcium level becomes more abnormal,
the risk to the patient is greater. Seizures and cardiac arrhythmias may develop,
which may become life-threatening.

SIGNS AND SYMPTOMS

• Irritability
• Paresthesia of lips (circumoral) and extremities
• Muscle spasm and cramping
• Tetany—intermittent painful tonic spasms, usually involving the arms and legs
• Abdominal pain due to muscle cell cramping within the gastrointestinal tract
• Laryngospasm and stridor (abnormal high-pitched breathing sound) as air-
way becomes narrowed
• Seizures due to irritation of nervous system tissue
• Cardiac arrhythmias due to increased excitation of cardiac muscle cells
• Prolonged QT interval will predispose to ventricular arrhythmias
• Contraction of facial muscle after tapping facial nerve anterior to ear
(Chvostek’s sign) due to increased excitation of nerve and muscle cells
• Carpal spasm after inflation of blood pressure cuff to upper arm—occludes
brachial artery and applies pressure to nerves (Trousseau’s sign)

TREATMENT
• Maintain intravenous access.
• High calcium diet to replenish lost calcium.
• Administer vitamin D if patient has deficiency; helps with absorption of
calcium:
• ergocalciferol (vitamin D2)
• Administer calcium gluconate 10 percent IV (emergency treatment for seizure,
tetany, cardiac arrhythmia).
• Administer calcium chloride (emergency treatment).

NURSING DIAGNOSES

• Imbalanced nutrition: less than what body requires
• At risk for injury

NURSING INTERVENTION
• Monitor vital signs for changes.
• Monitor intake and output.
• Monitor neurologic status for change, irritability, and disorientation.
• Monitor cardiovascular status for changes, irregularity of heartbeat, pulse
deficit (difference between heartbeat and peripheral pulse checked at the
same time), and cardiac rhythm.
• Monitor for signs of hypercalcemia when administering medication (can over-
medicate with calcium):
• nausea
• vomiting
• anorexia
• Explain to the patient:
• Avoid dependence on laxatives—these medications can alter bowel pat-
terns, causing altered absorption and excess elimination of calcium and
other electrolytes.
• Avoid dependence or overuse of antacids—these medications cause excess
intake of calcium (or other electrolytes, depending on composition).