Hypocalcemia


Last Updated December 20th, 2021

The role of calcium

Calcium is one of the minerals found as an electrolyte in your blood. But only less than 1% is present there and in extracellular fluid, muscles, and other tissues. Here it plays a major rule in vascular contraction and dilation, muscle contraction, glandular secretion, and nerve transmission. About 99% of it is in an uncharged state (deposited and forming your bones and teeth).

Calcium is the most abundant mineral in the human body. It combines with phosphorus to form your bones and teeth. It is biologically very important as it is required for the normal functioning of nerves and muscles and also participates in several enzymatic processes.

A normal, healthy teenager will have blood calcium levels that are a little over 10 mg/Dl. The highest blood calcium levels are seen between the ages 15 and 25. As you get older, calcium levels tend to decrease. A healthy patient in his 60s will have a calcium level in the 9s.

The states of calcium

Calcium is present in the blood in unbound and bound states. In the bound state, it exists in binding with albumin. Protein-bound calcium merely acts as a reserve source of calcium and has no active function in the body. In the unbound state, it acts as an electrolyte and helps in the vital functions of the body. Hypocalcemia is a medical condition in which there is a deficiency of unbound calcium. Therefore, it is important to measure the amount of unbound calcium in the blood, when the blood serum test is done. Unbound calcium also has an electrical charge, which is why it is also referred to as ionized calcium.

The role of Vitamin D

A transcellular pathway involves the transfer of solutes through epithelial cells instead of around them through intercellular spaces (paracellular pathway).

Vitamin D plays an important role in calcium absorption in the duodenum and upper jejunum. It mediates the active transcellular pathway for the absorption of calcium. Research suggests that the calcium-binding protein calbindin-D9k helps to facilitate calcium diffusion through the cell.

The paracellular pathway

There is also a passive paracellular pathway for the absorption of calcium. The paracellular pathway traverses the entire length of the intestine, predominates the distal regions. It also does not require Vitamin D for the absorption of calcium. The intake of calcium activates the passive absorption pathway.

Other substances that also help in calcium absorption

Other substances that enable calcium absorption or increase its bioavailability are lactose and casein phosphopeptides in milk. Estrogen, in women, also aids in calcium absorption. The absorption of calcium in the bowel and the reabsorption in the kidney is estrogen-dependent.

Factors affecting calcium absorption

The absorption of calcium is crucial in determining calcium intake or whether the preferred mode of calcium intake is actually helping. The factors affecting calcium intake are:

  • Amount consumed: As the intake increases, the absorption efficiency is reduced.
  • Age: Net calcium absorption is 60% in infants and young children because they need substantial amounts of calcium to build their bones. Absorption is decreased to 15–20% in adults (though it increases during pregnancy) and continues to decrease as people age.
  • Vitamin D: The intake of Vitamin D either as supplements or when produced under the skin in the presence of direct sunlight improves calcium absorption.
  • Other components: Phytic acid and oxalic acid found in plants can bind to the calcium and inhibit its absorption in the body.

Blood test to measure calcium level in the body

There are two types of blood tests to measure the level of calcium in your body.

  • A total calcium test measures the levels of both free and bound calcium. It is ordered by doctors most often.
  • An ionized calcium test, which measures the level of only free calcium.

What is hypocalcemia?

A deficiency of calcium in the bloodstream leads to a disease called hypocalcemia. The normal level of calcium in the bloodstream is 4.5-5.5 mEq/L. Other diseases associated with calcium deficiency are osteopenia and osteoporosis.

Measure of hypocalcemia

A measure of blood serum albumin is necessary to identify hypocalcemia. True hypocalcemia involves a reduction in total ionized calcium. Factitious hypocalcemia on the other hand only denotes a reduction in the total calcium in the blood serum.

How is hypocalcemia diagnosed?

The first step as described above is to determine the calcium levels in your blood. A physical exam, which includes a study of your hair, muscles and skin, may be followed by a mental examination. The mental examination for hypocalcemia involves checking for:

  • Dementia
  • Hallucinations
  • Irritability
  • Confusion

Chvostek’s and Trousseau’s Signs

The doctor may also check for Chvostek’s and Trousseau’s signs which indicated acute hypocalcemia. Chvostek’s sign is evidenced by a twitching response when a set of facial nerves is tapped. Trousseau’s sign is a twitching or spasm that is produced because of a restriction of blood supply to the tissues.

Causes of Hypocalcemia

A number of factors cause calcium deficiency. The most common cause of hypocalcemia is hypoparathyroidism, which occurs when the body secretes a less-than-average amount of parathyroid hormone (PTH). Low PTH levels lead to lower calcium levels in the body because PTH is the hormone that regulates the level of calcium in the body. Hypoparathyroidism is caused by the removal of the parathyroid gland from the body.

The other causes of hypocalcemia are:

  • Poor calcium intake, especially in childhood and sustained over a long period of time
  • Lactose intolerance or intolerance towards foods rich in calcium
  • Lower levels of Vitamin D, making it harder to absorb calcium
  • Medications, such as phenobarbital, phenytoin, rifampin, corticosteroids, and drugs that are used to treat elevated calcium levels
  • Pancreatitis
  • Septic shock
  • Massive blood transfusions
  • Renal failure (predominant in adults)
  • Hypermagnesemia and hypomagnesemia
  • Hyperphosphatemia
  • Certain chemotherapy drugs
  • Hormonal changes, especially in women, which lead to lower levels of estrogen
  • Certain genetic factors
  • Smoking can also lower the estrogen levels and in turn lead to calcium deficiency.

Risk Factors for Hypocalcemia

The following people are at a risk of developing hypocalcemia

  • Those with a history of gastrointestinal disorders
  • Women over the age of 50
  • Children who are premature and especially those born to diabetic mothers
  • Those suffering from anxiety disorders

Symptoms of Hypocalcemia

Hypocalcemia can present itself as asymptotic in mild cases or as a life-threatening condition in severe cases of hypocalcemia. The symptoms of hypocalcemia are:

Certain psycho-emotional symptoms are also observed in the case of hypocalcemia. They are:

Treatment of hypocalcemia

For the treatment of hypocalcemia, one must distinguish an acute case of hypocalcemia from a chronic case and also an asymptomatic case from a severely symptomatic one. In the case of a chronic case of hypocalcemia, where the condition is well tolerated, treatment must be such that it prevents long-term complications. In the case of an acute case of hypocalcemia, a rapid method of treatment is required. In every case, it is also important to identify the underlying cause for the condition.

Mild Hypocalcemia

Most cases of hypocalcemia are mildly symptomatic and respond well to treatment. In patients with mild hypocalcemia confirm true hypocalcemia. Mild hypocalcemia requires only supportive treatment. There may be further laboratory testing of PTH, if ordered by the doctor. Depending on the PTH level, the doctor may order testing for Vitamin D levels.

Severe Hypocalcemia

IV replacement is recommended in symptomatic or severe hypocalcemia with cardiac arrhythmias or tetany. Doses of calcium chloride or calcium gluconate (both of which are rich in elemental calcium) are administered. Calcium chloride delivers 3 times the elemental calcium that is delivered by calcium gluconate, but it must be used with caution. Calcium chloride must also be administered via central venous access (i.e., access to a large vein in the body).

In addition, oral calcium and Vitamin D treatment must be started early. Treatment with calcium and vitamin D for 1-2 days prior to parathyroid surgery may also help prevent the development of severe hypocalcemia.

Chronic Hypocalcemia

The treatment of chronic hypocalcemia also involves identifying the cause. Both hypoparathyroidism (where the body is unable to make enough parathyroid hormone) and pseudohypoparathyroidism (where the body is not able to respond to the parathyroid hormone) can be managed initially with oral calcium supplements.

Dietary Recommendations for Calcium Intake in Children

The dietary recommendations for children according to the health experts from HHS and USDA are mentioned below:

Age Group (in years)FemaleMale
1-3700700
4-810001000
9-1313001300
14-1813001300

As the ability to absorb calcium (which is as high as 60% in infants) drops, there is a need to increase calcium intake with age. This explains the recommendations.

Dietary Recommendations for Calcium Intake in Adults

According to the health experts from USDA and HHS, the dietary recommendations for the intake of calcium in adults are:

Age GroupFemaleMale
19-3010001000
31-5010001000
51+12001000

There is a drop in recommended calcium intake because the bone formation is near complete by the age of 19 and over, and therefore a steady intake of 1000 mg is recommended. With the increase in age beyond 50, however, in women, the risk of osteoporosis is higher and therefore the increased intake suggested for women.

How to improve calcium levels

The following tips will help to improve the levels of calcium in your blood.

  • Include dairy products in your diet. Choose from milk, cheese, yogurt, or milk-based custard. Research has shown that dairy products help increase calcium levels in the body in a much better way because of the presence of lactose.
  • Leafy green vegetables are good for you. Include a serve of broccoli, cabbage, or spinach during both lunch and dinner every day.
  • Eat foods rich in vitamin D. Fatty fish like salmon or tuna, mushrooms, and egg yolks contain vitamin D. Vitamin D can also be obtained by regular exposure in the sun, but make sure you have got that sunscreen on.
  • Eat more of fresh fish. If you cannot get fresh fish, eat tinned fish such as sardines or salmon that have their bones left in.
  • Replacing the meat in your meals with tofu or tempeh also helps to reduce the saturated fats in your diet and this, in turn, improves calcium levels.
  • Snack on calcium-rich nuts like almonds or Brazil nuts. Keep a container of nuts and seeds with you and have a small handful as a daily snack.
  • Reduce your intake of caffeine, soft drinks, and alcohol. They all inhibit calcium absorption and should be used in moderation.
  • Sprinkle sesame seeds over vegetables or salads. Sesame seeds are easy to include in all meals and are high in calcium.
  • Try calcium-fortified foods for a more healthy breakfast. Some breads, cereals and even milk are now calcium fortified.
  • Educate your children on the importance of dairy products in their diets. Substitute soymilk with regular milk and if that doesn’t work add calcium to the soymilk.
  • Lactose-free yogurts will still help you if you are lactose intolerant. These products also have calcium in them.

Final Words

Hypocalcemia is a condition resulting from a deficiency of calcium. Calcium is a mineral that is most abundant in the body and it is the change in a 1% of it that affects the body severely. Our body is therefore highly sensitive to calcium. It is important to understand this and include calcium in your diet every day. If you are unable to do so or are unable to find a suitable diet, please use calcium supplements. They evidently work the same magic with less pain!

Facts

  • The incidence of ionized hypocalcemia is difficult to quantify.
  • In a study conducted in 2011-2014, the incidence of transient hypocalcemia after thyroidectomy (thyroid removal) was 27% and that of permanent hypocalcemia was 1%.

Facts

  • Hypocalcemia can be caused by a lack of vitamin D.
  • Most cases of hypocalcemia have no symptoms.

Facts

  • Death is rare in hypocalcemia but has been reported in some cases (data not available).
  • Both lab tests and imaging are always required for the detection of hypocalcemia

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Test Your Knowledge

Welcome to your Nutrient Deficiency Quiz

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Which disorder is characterized by inability to speak in certain social situations?
Beriberi is caused by the lack of this micronutrient-
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People with darker skin are more prone to vitamin D deficiency.
If you have thiamine deficiency, which of these should you avoid consuming with your thiamine rich diet?
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Consumption of mushrooms exposed to UVB rays help with low vitamin D levels.

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Dos and Don'ts

Dos
  • Let your doctor know of any recent medications when presenting with hypocalcemia.
  • Increase your vitamin D and lactose intake along with calcium intake for better results.
Don'ts
  • Take medications that reduce calcium levels without consulting your doctor.
  • Take calcium supplements without reading warnings and recommended dose.

 

 

 

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Hysteroscopy Hysteroscopy is a minimally invasive tool to help specialists view the uterus to diagnose and even treat several…
thyroid_scan
Thyroid Scan Thyroid scan is a diagnostic procedure that aims to view the thyroid gland and detect any growths or…
malarial antigen test
Malaria Antigen Test A malaria antigen test is a rapid diagnostic test (RDT) that can detect malarial antigens (proteins) in your…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
lose weight fast
12 easy and instant steps to successful weight loss Do you want to lose weight without losing your mind? Does weight loss always mean saying goodbye to…
50 common health conditions
What are the top 50 deadly and widespread diseases? A complete list of the top 50 most common and deadly diseases that plague humanity. Which disease is…
Juice Plus: Can you really replace actual fruits with pills?  Juice Plus supplements intend to fill nutritional gaps present in our daily diet. But how successful have they…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Plexus Slim: Is this pink slimming drink the ultimate one-stop fat burner? How effective is Plexus Slim in helping people lose weight? What are its ingredients? Can it be safely…
Tamarind: The top health benefits of this staple Asian ingredient Did you know this sweet and sour pulpy fruit does more than just add a tangy flavor to…
Vagus nerve: 7 health benefits of stimulating the “gut-brain” connection As a matter of fact, there are two vagus nerves namely the left and the right but is…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
Jackfruit: Slice your way into higher immunity, better digestion, & more… Native to the South East Asia, the jackfruit is a fruit brimming with thousands of health benefits. Discover…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
Piaget stages: Do they accurately describe the way the human brain develops?  A common assumption was that children are less competent thinkers as compared to adults, but this was refuted…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…
colposcopy
Colposcopy Colposcopy is a simple, quick and non- invasive diagnostic tool to look closely inside the vulva, vagina, and…
CEA_test
Carcinoembryonic antigen (CEA) test CEA or carcinoembryonic test detects the presence of CEA antigen in your blood mainly & determines the effectiveness…
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
nature health benefits
Green Healing: The amazing health benefits of being in nature You have no idea what sitting in a closed room does to your body and mind.Can a stroll…
Jicama: A fiber-rich tuber for your weight loss goals Pronouced as HEE-kah-ma, Jicama is the "new kid on the block" that has taken the world by the…
dandelion weight loss
Caralluma Fimbriata: How to eat this cactus to lose weight Caralluma fimbriata is a miracle cactus that can be safely consumed by most for losing weight and boosting…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
Atkins diet weight loss
Atkins Diet: The right steps to carb control that can help you lose those pounds fast The Atkins diet is a high fat, low-carb diet with proven weight loss benefits that is flexible enough…
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
chloride test
Chloride Test A chloride test of the blood checks the level of chloride in body, an important factor governing the…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
C-Reactive Protein Test A CRP or c-reactive protein blood test is an important diagnostic tool used to determine the risk of…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
valproic acid test
Valproic Acid Test Valproic acid test is performed to generally check for psychiatric and even neurological conditions such as bipolar disease…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
acne removal tips
Anatomy of acne: 7 instant steps to kiss those zits goodbye Blackheads, whiteheads, or pimples-call them what you may. Acne is never good news.Did you know some of the…