Diagnosis and Management of Hypocalcaemia in Adults

Abstract

Extracellular calcium is important for the regulation of several important biological systems, particularly muscle function, intracellular signalling and coagulation. Serum calcium levels are therefore maintained in a tight physiological range, largely by parathyroid hormone (PTH) and vitamin D. Hypocalcaemia has many causes, the commonest of which are vitamin D deficiency, malabsorption, chronic kidney disease, hypoparathyroidism and acute severe illness. Acute severe hypocalcaemia is a medical emergency, and may manifest with muscle spasm, tetany, seizures or cardiac arrhythmias. In patients with hypoparathyroidism, long-term maintenance therapy with oral calcium and vitamin D metabolites is indicated. Care should be taken to restore serum calcium levels to low-normal levels, whilst avoiding hypercalciuria and the development of undesirable renal sequelae.