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Calcium Normal values
4.5 – 5.5 mEq/L
Calcium Normal Function
Major cation in teeth and bones (99%)
Found equally in ICF and ECF (1%)
Helps cells to adhere to one another & maintain their shape
Helps muscles contract
Aids in coagulation
Affects cell membrane permeability & firing level
Hypercalcemia causes
Increased absorption from GI
Decrease excretion by kidneys
Hyperthyroidism
Multiple fractures
Hypophosphatemia & acidosis
Cancer
Medications
Hypocalcemia Causes
 Ca intake
Excessive Ca loss
 Ca absorption
Alcoholics
 exposure to sunlight
Renal failure
 Phosphorus levels
Pancreatic insufficiency
Medications
Clinical Manifestations of Hypocalcemia
Easy fatigability
Depression, anxiety, confusion
Numbness & tingling in extremities in extremities & around mouth
Hyperreflexia, muscle cramps
Trousseau’s/Chvostek’s
Laryngeal spasm
Tetany, seizures
Impairs clot time (easier to bleed)
On ECG ST segment decreases & QT shortened
Clinical Manifestations of Hypercalcemia
Lethargy, weakness
Depressed reflexes
Decreased memory
Confusion, personality changes, psychosis
Anorexia, nausea & vomiting
Bone pain, fractures
Polyuria, dehydration
Nephrolithiasis
Stupor, coma
Positive Chvostek sign
Blinking when you touch cheek
Positive Trousseau's Sign
BP cuff. internal roation of arm
Treat Hypercalcemia
Expand fluid volume to increase renal clearance
Mild (11-14)
0.9 NaCl promotes calcium loss
Loop diuretic to prevent fluid overload
Sever (>14)
Same as above add calcitonin 4 units/kg, sc
Treat Hypocalcemia
Oral supplements
IV Calcium diluted in D5W
Correct underlying cause
Monitor for digitalis toxicity