Hypocalcemia in adults and children – causes, treatment and symptoms of the disease

There are two forms of the disease: chronic and acute hypocalcemia. The symptoms of the latter are characterized by the emergence of a massive cytolysis syndrome. In this case, ionized calcium is quickly removed from the blood. Pathology is characterized by rapid progression, if cytolysis is also accompanied by renal failure.

There is another classification of the disease. Hypocalcemia occurs:

  1. Functional (develops as a result of disruption of the internal organs).
  2. Toxic (formed by the use of certain groups of drugs, the influence of toxic substances).
  3. Violation of the usual regulation of calcium-phosphorus-magnesium metabolism.

Can the development of hypocalcemia be prevented?

Here’s something important to clarify: you should never take calcium supplements on your own. This is what the doctor must decide. Self-medication is always very dangerous.

Even if it seems to us that we are suffering precisely from a deficiency of calcium, “just in case” it is impossible to take this mineral. It is best to consult a doctor and find out for sure, and with it the necessary dosage (everyone will have their own dosage).

  • It is also important to recall that calcium is not only found in dairy products. This mineral can be found in legumes (chickpeas or lentils, for example), as well as in chicken eggs, nuts, broccoli, etc.
  • In fact, it is simply about maintaining a varied and balanced diet, where there is no shortage of any nutrients.
  • To prevent hypocalcemia, it is very important to fill the deficiency of magnesium and vitamin D in the body.
  • Also do not forget about exercise. Walking on a sunny day will contribute to the synthesis of vitamin D.

Remember: if in doubt, consult a doctor. It is the specialist who should prescribe you to take certain nutritional supplements.

In addition, it is necessary to take care of the health of the thyroid gland, since its work is also directly related to the level of calcium in the body.

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Features of hypocalcemia in children

Hypercalcemia refers to one of the forms of impaired mineral metabolism and the frequency of occurrence of this pathology in comparison with hypocalcemia is much lower, but despite this fact, this pathology in childhood is always difficult and needs immediate medical correction.

The appearance of certain clinical manifestations of hypercalcemia depends on the age of the patient and the degree of increase in blood serum calcium saturation. For different age categories, the development of different forms of this pathology is characteristic, which are fundamentally different in the nature of the occurrence of hypercalcemia and, accordingly, approaches to its treatment.

So, the neonatal period is considered critical in relation to the development of Williams syndrome, which in pediatrics has the second name “idiopathic hypercalcemia”. The cause of this pathology is a congenital genetic mutation, and the main pathogenetic mechanism of hypercalcemia is an increase in the absorption of calcium in the small intestine.

Considering the experience of long-term follow-up of patients suffering from idiopathic hypercalcemia, a classical triad of clinical signs was determined: a sharp lag in mental development, gross vascular abnormalities and a change in the facial section of the skull with the formation of the phenotypic “elf face”. Over time, in children suffering from this form of hypercalcemia, cognitive and intellectual disorders manifest themselves to a greater extent.

Unfortunately, at present, it has not been possible to develop diagnostic methods for determining the signs of Williams syndrome in the prenatal period. The main therapeutic measures for this pathology are limiting the child’s daily intake of calcium, as well as adhering to the mother’s specific dietary intake during lactation, monitoring the dosage of vitamin D solution, and glucocorticosteroid therapy is only severely allowed (Hydrocortisone in a daily dose of 10 mg per 1 kg baby weight).

Also, a congenital form of hypercalcemia is the family heterozygous type, which is characterized by a benign course and the absence of specific clinical signs that allow for the early diagnosis of this pathological condition.

Familial hypercalcemia is most often an accidental finding during a routine screening laboratory examination of a child and does not require the use of medication.

Hypocalciuric hypercalcemia belongs to the category of emergency conditions requiring immediate medical intervention, since this pathology is characterized by a rapidly progressing aggressive course. Manifestations of this form of hypercalcemia are observed immediately after the birth of the child, and consist in the development of gross congenital malformations of the skeleton, a sharp delay in the physical and mental development of the newborn.

In addition to the critically high level of calcium in serum, the biochemical laboratory criteria for this pathology include an increase in the concentration of parathyroid hormone and a significant decrease in the level of calcium in the urine. Due to the fact that hypocalciuric hypercalcemia in most cases has an unfavorable outcome, immediately after birth, children are recommended to perform the removal of the parathyroid glands with simultaneous autotransplantation of the parathyroid tissue into the region of the forearm muscle mass. Long-term rehabilitation treatment consists in the use of calcium-containing drugs and a solution of vitamin D.

The non-specific form of hypercalcemia, which is observed both in the adult category of patients and among children, is immobilization. This pathology develops as a result of demineralization of bone tissue in areas that have long been in an immobilized position with severe polytrauma or burn damage.

In this regard, the most effective way to prevent the development of signs of hypercalcemia in this group of patients is to activate them in the early rehabilitation period. If there are signs of immobilization hypercalcemia, an adequate diuretic therapy regimen has good effect (Furosemide at a calculated dose of 1 mg / 1 kg of the child’s weight intravenously).

If the intake of synthetic vitamin D synthetic drugs, which is used both as a preventative and therapeutic agent in the chest period, is not followed, conditions are created for the development of signs of hypercalcemia. In this situation, the initial measures are to immediately stop taking the drug containing vitamin D, as well as correcting the child’s eating behavior, which means abstaining from the use of calcium-containing foods.

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This pathology can be diagnosed in children of any age. The lack of calcium and phosphorus in the diet, vitamin D – is the most common reason that explains the occurrence of a disease such as hypocalcemia. The symptoms of this disease are most pronounced if the child has increased physical and mental stress. It has the following clinical features:

  • Atypical tetany, which is manifested in clumsiness during movements.
  • Spasms of the gastrocnemius muscles.
  • Persistent diarrhea.
  • Increased intracranial pressure.
  • Laryngospasm.

Hypocalcemia in children is a very serious pathology requiring immediate treatment. Inattention to the health of the child can lead to the development of the most unexpected complications.

Symptoms

A mild form of hypercalcemia can be asymptomatic. More severe forms are accompanied by the appearance of symptoms in parts of the body that are affected by high levels of calcium. For instance:

  • The kidneys. With an excess of calcium in the blood, the kidneys are forced to work harder to remove it from the body. This leads to increased thirst and frequent urination.
  • Digestive system. Hypercalcemia causes indigestion, nausea, vomiting, and constipation.
  • Bones and muscles. In most cases, excess calcium is washed into the blood from the bones, which leads to their fragility. The result is bone pain. In some cases, hypercalcemia is also accompanied by muscle weakness.
  • Brain. Hypercalcemia affects the functioning of the brain, causing confusion, lethargy and fatigue.

If you see signs and symptoms of hypercalcemia, such as increased thirst, frequent urination, and abdominal pain, you should consult a doctor.

Complications

Osteoporosis. If calcium is leached from the bones into the blood over time, bone density decreases and osteoporosis develops, leading to fractures, curvature of the spine and loss of growth. Stones in the kidneys. With a high calcium content in the urine, crystals form in the kidneys. Over time, crystals form kidney stones.

Excretion of the stone is accompanied by extremely painful sensations. Renal failure. Severe form of hypercalcemia disrupts the kidneys, limiting their ability to cleanse the blood and remove fluid. Disturbances from the nervous system. Severe hypercalcemia causes confusion, dementia and coma, which can lead to death.

Reduced or increased calcium in the blood equally negatively affects the work of the whole organism. If symptoms of hypocalcemia appear, you should immediately seek help from a doctor and undergo the recommended course of treatment. Otherwise, the likelihood of developing quite dangerous health complications increases.

Symptoms and signs of hypercalcemia

    • Routine biochemical screening in patients without symptoms of hypercalcemia.
    • Common symptoms: depression (30-40%), weakness (30%), fatigue and malaise.
    • Gastrointestinal symptoms: constipation, lack of appetite; vague abdominal symptoms (nausea, vomiting), weight loss.
    • Renal symptoms: kidney stones (with prolonged course of hypercalcemia); nephrogenic diabetes insipidus (20%); renal tubular acidosis of type 1; prerenal renal failure; chronic hypercalcemic nephropathy, police polydipsia or dehydration.
    • Neuropsychiatric symptoms: agitation, depression, cognitive impairment; coma or stupor.
    • Cardiological symptoms: hypertension, arrhythmia.
    • Gastrointestinal symptoms: abdominal pain, nausea / vomiting, constipation, pancreatitis
    • Renal symptoms: polyuria (due to the diuretic effect of hypercalcemia and ADH-resistance of the kidneys) and associated polydipsia, impaired renal function, nephrolithiasis
    • Neurological symptoms: confusion, proximal muscle weakness and fast muscle fatigue, weakened reflexes, fatigue, headaches, rarely ataxia, dysarthria and dysphagia, impaired consciousness up to coma
    • Psychiatric symptoms: depression, fear, stupor, psychosis
    • Cardiovascular symptoms: in the early phase, hypertension is more likely, in the dynamics of hypotension (due to dehydration), cardiac arrhythmias, circulatory arrest
    • Other: bone pain, osteopenia with an increased risk of fractures, weight loss, itching

With a rapid increase in calcium concentration, a hypercalcemic crisis may develop with exsicosis, confusion and impaired consciousness, and severe renal impairment.

The acute form of hypocalcemia is a rather serious ailment, in which there is a syndrome of massive destruction of special cells – zukaryotes. This situation occurs with traumatic shock, burns, hemolysis, and the use of cytostatics. In this case, ionized calcium rapidly leaves the blood. The situation of the patient is even more complicated if cytolysis, the destruction of these cells, is combined with acute renal failure.

The chronic form of the syndrome is expressed by titanium and increased neuromuscular excitability. Therefore, signs of hypocalcemia are expressed by paresthesia – numbness, tingling, and goosebumps. In addition, laryngospasm (sudden contraction of the muscles of the larynx), bronchospasm (narrowing of the bronchi), and convulsions are observed.

Cramping occurs on the feet, hands, and muscles of the face. Patients have depressive states, psychoses, and often short-term respiratory arrest occurs.

Sometimes hypocalcemia is manifested by hypocoagulation and hemorrhagic syndromes. In this case, increased bleeding occurs as a result of a decrease in blood coagulability and vascular wall permeability due to a lack of calcium in the body.

Calcium deficiency leads to brittle hair and nails, impaired heart rhythm and the development of cataracts, diseases of bones and teeth.

If hypocalcemia leads to impaired brain activity, then the symptoms are expressed by loss of memory, delirium, confusion, hallucinations. If proper medical measures are quickly taken, then these processes are reversible.

Initially, hypercalcemia is characterized by a latent course in which the patient does not have any pain or the symptoms are so nonspecific that the patient cannot recognize the cause of their occurrence. At this stage, this disease should be attributed to the category of random finds during a screening laboratory examination of the patient.

To a greater extent, patients suffering from hypercalcemia of one degree or another, complain of various dyspeptic disorders (nausea, lack of appetite, heartburn). During the expanded clinical picture, hypercalcemia is manifested by symptoms of intestinal obstruction (prolonged constipation, flatulence, spastic pain in the projection of the abdominal cavity without a clear localization).

In a situation where the patient has hypercalcemia with a significant increase in the concentration of calcium in the body, severe clinical symptoms develop, which requires urgent medical intervention. The patient becomes emotionally labile, and in a far advanced stage, various degrees of impaired consciousness from somnolence to coma are noted.

Prolonged hypercalcemia is always accompanied by transient or chronic renal failure due to the formation of many microcalcifications in the thickness of the renal parenchyma. It must be remembered that a violation of the urinary function of the kidneys provokes the development of persistent malignant hypertension in a patient with hypercalcemia, which in some cases is the only clinical manifestation of this disease.

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If hypercalcemia occurs against the background of hyperparathyroidism, the patient has a tendency to form peptic ulcers and signs of acute pancreatitis. Long-term severe hyperthyroidism is accompanied by the development of generalized fibrous osteodystrophy, which is characterized by an increase in the activity of osteoclasts and, as a result, the formation of sites of fibrous degeneration and cystic remodeling of bone tissue of various localization.

The risk category for this pathology is patients with renal failure who are on prolonged dialysis, as well as patients with a secondary form of hyperparathyroidism. Laboratory confirmation of fibrotic osteodystrophy is a significant increase in serum alkaline phosphatase.

Statistics prove the possibility of death in hypercalcemia. A fatal outcome occurs with the development of shock and acute renal failure.

  • Violation of wakefulness, attention and concentration
  • Convulsive seizures
  • Paresthesia, tetany
  • Confusion, state of fear, agitation, hallucinations, depression
  • Chorea syndrome and Parkinson’s syndrome in chronic hypocalcemia
  • AV blockade, circulatory arrest

To do this, apply the tonometer cuff as usual and squeeze the artery for 3 minutes. As a result, a characteristic spasm of the hand develops (a symptom of Trousseau). Less reliably reveals a latent tendency to convulsions, Khvostek’s symptom – when the finger strikes the exit area of ​​the facial nerve with a finger, spasms of the muscles of the face occur on the same side.

According to the results of the ECG, the Q — T interval can be lengthened, which predisposes to the development of ventricular arrhythmia. Prolonged hypocalcemia and hyperphosphatemia (for example, with hypoparathyroidism) can cause cataracts, calcification of the basal ganglia and epilepsy. Hypocalcemia and hypophosphatemia due to vitamin D deficiency in adults cause osteomalacia.

Hypocalcemia is often asymptomatic. The main clinical manifestations of hypocalcemia itself are associated with changes in the membrane potential of cells, causing neuromuscular excitability.

Neurological manifestations. Often there are spasms of the muscles of the back and legs.

Typically, tetany is associated with severe hypocalcemia, but occurs with a decrease in only the ionized Ca fraction in the absence of obvious hypocalcemia.

A tetany can be either explicit, manifested by spontaneous symptoms, or latent, which is detected only with the help of provocative manipulations. Latent tetany is usually found with a lower decrease in serum Ca concentration.

Other manifestations. For chronic hypocalcemia, other manifestations are also characteristic: dryness and peeling of the skin, brittle nails and hair stiffness. Candida infections sometimes develop (especially often with idiopathic hypoparathyroidism). With prolonged hypocalcemia, cataracts are also noted, and correction of serum Ca level does not lead to its reverse development.

What treatment is required?

With this disease, it is extremely important not only to compensate for the calcium deficiency, but also to eliminate its possible causes.

In hypoparathyroidism, patients are prescribed replacement therapy using hormonal drugs. In this case, it is important to eliminate the underlying disease as soon as possible and to prevent hypercalcemia (a condition in which there is increased calcium in the blood). If the patient has no problems with the absorption of drugs in the small intestine, such therapy for a short period of time can lead to positive results, including with a severe form of the disease.

With attacks of tetany, calcium chloride solutions are administered intravenously. Keep in mind that these drugs irritate the walls of the veins. Therefore, it is better to make injections through the central catheter or into a large vein.

To treat the disease in the chronic stage, patients are prescribed vitamin D (for example, Calcitriol, Ergocalciferol), as well as calcium tablets in tablet form. The dosage of drugs is selected individually, depending on the characteristics of the course of the disease called “hypocalcemia.”

Treatment also includes following a special diet. The diet should be fortified with foods high in magnesium and vitamin D (milk, dried fruits, vegetables, a variety of cereals). For the entire period of therapy, it is recommended to abandon excessively fatty foods, smoked meats, pastries and pickles. Food should be fractional.

Hypercalcemia: causes of the disease

The development of hypercalcemia can be triggered by increasing the level of absorption in the gastrointestinal tract of calcium, as well as with an excess of its intake in the body. Often there is a development of the disease among people taking a significant amount of calcium (for example, during the development of peptic ulcer disease) and antacids that also contain calcium. The use of large volumes of milk in the diet acts as a complementary factor.

It has its own effect on increasing the concentration of calcium in the blood and an excess of vitamin D, which, in addition, helps to increase its absorption through the digestive tract.

Meanwhile, most often hypercalcemia occurs due to hyperparathyroidism (excessive production of parathyroid hormone by one or more parathyroid glands). About 90% of the total number of patients diagnosed with primary hyperparathyroidism encounter a benign tumor of one of these glands.

Clinical manifestations of hypercalcemia

Mostly hyperparathyroidism develops among women and the elderly, as well as among those patients who have undergone radiation therapy for the cervical region. In some cases, hyperparathyroidism forms as such a rare inherited disease as multiple endocrine neoplasia.

Hypercalcemia for patients with their malignant tumors is becoming quite common. So, malignant tumors localized in the lungs, ovaries or kidneys begin to produce excess protein, it subsequently affects the body by analogy with parathyroid hormone.

Ultimately, this forms a paraneoplastic syndrome. The spread (metastasis) of a malignant tumor is possible to the bones, which is accompanied by the destruction of bone cells while simultaneously contributing to the release of calcium into the blood. This course is characteristic of tumors, which are formed in particular in the area of ​​the lung, mammary and prostate glands. A bone marrow-afflicting malignant tumor can also contribute to bone destruction along with hypercalcemia.

In the process of the development of another type of malignant tumors, an increase in the concentration of calcium in the blood is currently not explainable due to the incomplete study of such a course of pathology.

It is noteworthy that hypercalcemia can also be a companion of many diseases in which bone destruction or loss of calcium occurs. As one of such examples, we can single out Paget’s disease. The development of hypercalcemia may also be caused by impaired mobility, which is particularly relevant for paralysis or length of stay in bed. These conditions also lead to calcium loss by bone tissue during its subsequent transition into the blood.

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Postpartum paresis is usually observed in cows, goats, and less commonly in pigs. The causes of this disease have not yet been fully studied, but with the help of various observations it was found that paresis most often manifests itself:

  • in animals whose diet is rich in protein feed;
  • in well-fed individuals;
  • in cattle with highly productive dairy qualities;
  • during 5-8 lactation.

This disease, as a rule, manifests itself in the first 3-4 days of the postpartum period. Also often occurs in animals after lungs or rapid delivery. Rarely, this disease appears later than the specified period or during childbirth. In some individuals, paresis may recur after each birth. These are very rare cases and they have been observed only in cows and goats.

With paresis, hypocalcemia is observed – a decrease in the level of calcium in the blood of the animal, and against this background, phosphorus and magnesium increase. The parathyroid gland is responsible for the amount of calcium in the blood, and it is a violation of its functionality, according to some scientists, that leads to this disease. Hypocalcemia is also characterized by active leaching of calcium with milk, therefore animals with high milk productivity are at risk.

One of the causes of paresis is also considered to be a high nervous strain. All animals with this diagnosis showed low sugar levels in blood tests, which is also considered the cause of the disease.

The only causes that are known so far are that intracorporal genetic determinants of the environment work here. Under their influence, functional changes in muscle cells occur. Their work is affected by the amount of sodium and calcium ions in the muscle membranes. It is the genetic tendency to lack of control of these ions that causes this disease. Various shifts in carbon and protein metabolism are also observed. It must be assumed that the disease arises from severe depletion of the nervous system.

Prevention

Prevention of paresis should be carried out in the antenatal period. Since this disease is characterized by a decrease in the blood sugar of a cow, it is necessary to give it 3 g of sugar per day 4-500 days before calving.

Immediately after giving birth, you need to water the cow with water with the addition of 100-120 grams of salt. A good preventive effect is the addition of minerals to the diet of a pregnant cow. You can also prevent paresis by adding 100 grams of ammonium chloride to the feed. Favorable conditions of detention, the absence of drafts and temperature changes are the key to the health of a cow. Some studies have shown that maternal paresis in a cow can occur precisely because of a cold.

Following a proper diet a few weeks before giving birth also helps prevent this disease. Concentrates and succulent feed must be removed from the diet of the cow.

Remember that prophylaxis must be performed before symptoms of paresis in the cow. You can’t pour sugar and water into the animal by force when the disease has already begun to manifest. Proper and balanced nutrition is the key to the health of your animal.

For the prevention of hypocalcemia, patients are recommended:

  • regularly eat foods rich in calcium, vitamin D, magnesium;
  • timely treat kidney disease, gastrointestinal tract;
  • reduce the use of laxatives.

This article is posted for educational purposes only and is not scientific material or professional medical advice.

Text approved by endocrinologist
Murashko (Mirina) Ekaterina Yuryevna

preventive measures

How can a disease such as hypocalcemia be prevented? The symptoms of this pathology worsen the quality of life so much that many patients unwittingly ask this question.

First of all, experts strongly recommend that you review your daily diet. It is better to remove from it all the harmful products, add more healthy and proper food. In order to prevent the development of the disease, doctors advise to adhere to the principles of proper nutrition: steam or bake in the oven, eat often and in small portions. It is very important to diversify the diet with foods high in magnesium and vitamin D.

It is recommended to limit the use of laxative drugs. If there are problems with intestinal peristalsis, it is necessary to consult a relevant specialist. It will help to understand not only the main cause of constipation, but also selects the most effective therapy.

How else can you prevent the disease? The causes of this pathology are often hidden in the incorrect functioning of the gastrointestinal tract. However, timely treatment of diseases of the kidneys and the gastrointestinal tract allows you to avoid problems with calcium deficiency in the blood.

We hope that all the information presented in this article about the disease that is so widespread today will actually be useful for you. Be healthy!

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Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

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