Hypocalcemia


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

Related Conditions

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Test Your Knowledge

Welcome to your Nutrient Deficiency Quiz

What type of sun rays help synthesize vitamin D?
Which disorder is characterized by inability to speak in certain social situations?
Beriberi is caused by the lack of this micronutrient-
Can stuttering be genetic?
Which of these vitamins are needed for calcium absorption by the body?
What is scoliosis?
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?
Which of the following is a speech disorder that affects the pronunciation of letters like s, z, r?
Consumption of mushrooms exposed to UVB rays help with low vitamin D levels.

Take the full quiz

 

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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Bone Marrow Biopsy Bone marrow biopsy is a diagnostic procedure where a small amount of bone marrow is extracted from hip…
gallbladder diet tomato
Gallbladder surgery :Tips on post-operative care and diet What to eat post a gallbladder surgery? What are the key things to avoid if you had a…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
Urologist: When should you visit one and why? A urologist can treat not only genitourinary problems of both men and women but also can treat various…
Top natural diuretics: The instant benefits you can get from nature’s water pills Since diuretic drugs are known to cause side effects, it is better to choose a natural diuretic that…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
Inhale oxygen, exhale worries: The top breathing exercises and how to perform them Performing the breathing exercise is like becoming mindful of how you breathe.  Here is a list of breathing…
antinuclear antibody test
Antinuclear Antibody Test – (ANA) Antinuclear antibody or ANA test is a blood test that measures the level of ANA antibodies that are…
PROGESTERONE_test
Progesterone test The progesterone test is a blood test used to determine the level of hormone progesterone in the blood…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
AHBC Igm
Anti-Hepatitis B Core Antigen (AHBc) IgM Anti-hepatitis B core antigen (AHBC) IgM is an investigative procedure to detect the presence of IgM antibodies in…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
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…
waking up tired
10 reasons why you might be waking up tired Do you feel you are not getting enough sleep? Sleep-deprived and frustrated? Read on discover the real reasons…
bananas exercise
10 health reasons why you should go “bananas” over bananas! Bananas:The world's most popular fruit comes with a host of unbelievable health benefits. Find out how you can…
Anhedonia: Does the chronic inability to feel joy affect you too? How often do you feel dragged down by an invisible force? Do you feel an inexplicable emotional numbness…
Vitamin D foods: Know what to eat for stronger bones and a cancer-free body Foods with vitamin D can actuallly transform your health. Observe fewer body aches, high energy, stronger brains, and…
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…
Hemp Seeds: The actual science behind this controversial crop Inspite of being credited as a superfood, hemp seeds are still shrouded with layers of controversies. Are these…
RHABDOMYOLYSIS muscle cramps
The hidden dangers of magnesium deficiency and how you can prevent it Magnesium is an essential mineral for the body.Its deficiency can cause harm to your vital organs. Find out…
11 unbelievable health benefits of thyme you didn’t know! Thyme is a herb that has been used in alternative medicine.It is a well known seasoning in the…
PROSTATE-SPECIFIC-ANTIGEN
Prostate-Specific Antigen (PSA) Test Prostate specific antigen test is a blood test used to determine the presence of prostate cancer or any…
TSH test
TSH Test – Thyroid Stimulating Hormone TSH test measures the level of thyroid secreting hormone in the blood. The level of this hormone is…
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
Amniocentesis test
Amniocentesis Amniocentesis is a diagnostic procedure for pregnant women to assess and detect the presence of any chromosomal or…
EEG
Electroencephalogram – EEG EEG or electroencephalogram is a diagnostic tool used to access the functioning of neurons and brain activity to…
Hysteroscopy_procedure
Hysteroscopy Hysteroscopy is a minimally invasive tool to help specialists view the uterus to diagnose and even treat several…