Hypocalcemia Hypercalcemia A 45-year-old male with a history of medullary thyroid cancer presents with abdominal pain, muscle cramps, and tetany. On PE he has facial nerve twitching after tapping. EKG shows a prolonged QT interval. A 65-year-old with multiple myeloma presents with confusion, severe depression, vomiting, constipation, and polyuria. EKG shows shortened QT interval. Introduction Introduction Causes include hypoparathyroidism acute pancreatitis medullary thyroid cancer hypomagnesium lack of vitamin D blood transfusion Serum pH affects the homeostasis of the 3 forms of plasma calcium (ionized calcium, albumin-bound calcium, and calcium bound to inorganice and organic anions). increase in pH can result in reversible symptoms of hypocalcemia Causes include malignancy (most common symptomatic cause) hyperparathyroid disorders (most common asymptomatic cause) bone disorders kidney disorders immobilization Presentation Presentation Symptoms abdominal pain tetany muscle cramps dyspnea perioral tingling convulsions mental status changes Physical exam hyperactive reflexes carpal tunnel spasm after blood pressure readings (Trousseau's Sign) facial muscle contractions after tapping on the facial nerve (Chvostek's Sign) Symptoms bones fractures stones nephrolithiasis groans anorexia vomiting constipation psychic overtones weakness fatigue altered mental status Evaluation Evaluation EKG may show prolonged QT interval Lab differential workup should include calcium phosphate PTH TSH vitamin D Of note, individuals with low albumin can have low total plasma calcium since their levels of ionized calcium are relatively normal, they may be asymptomatic EKG may show QT interval shortening Lab differential workup should include calcium phosphate PTH TSH vitamin D albumin Treatment Treatment Treat underlying cause Give calcium gluconate Vitamin D supplement Calcium restriction IV hydration (watch for CHF) followed by furosemide diuresis ("loops lose calcium") In severe cases: calcitonin pamidronate (and bisphosphonates especially for hypercalcemia of malignancy) corticosteroids Avoid thiazide diuretic