hipokalcemii

Hypocalcemia, or hipokalcemie in some languages, is a medical condition defined by a lower than normal concentration of calcium in the blood. Serum calcium is measured as total calcium, which depends on albumin, and ionized calcium, the physiologically active form. Because albumin affects total calcium, corrected calcium or ionized calcium is preferred in many clinical settings, especially when albumin is abnormal.

Causes include hypoparathyroidism (often after thyroid or parathyroid surgery), magnesium deficiency, vitamin D deficiency, and chronic kidney disease. Other contributors are pancreatitis with fat saponification, malabsorption, liver disease, and medications such as loop diuretics, citrate in blood products, bisphosphonates, and certain anticonvulsants.

Clinical features range from asymptomatic to severe neuromuscular symptoms. Common complaints include perioral numbness, tingling, muscle cramps, and tetany. Signs such as Chvostek and Trousseau can be present. Cardiac effects may include QT prolongation and, in severe cases, arrhythmias.

Diagnosis relies on laboratory tests and assessment of the underlying cause. Key tests are serum calcium, albumin, phosphate, magnesium, and parathyroid hormone levels, with 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D as indicated. Ionized calcium is preferred when precise assessment is needed, particularly in critical illness or when albumin is abnormal.

Treatment depends on severity. Symptomatic or severe hypocalcemia is treated with intravenous calcium (commonly calcium gluconate) to rapidly raise levels, followed by oral calcium citrate or carbonate with active vitamin D analogs (calcitriol) as maintenance. Correct magnesium if deficient and treat the underlying cause; monitor electrolytes and adjust therapy accordingly.

Prognosis is generally favorable with appropriate treatment, though chronic hypocalcemia requires ongoing management.