Hypocalcemia

Hypo: low

Calc: pre-fix is calcium

Emia: blood

Meaning of hypocalcemia: Low calcium in the blood

Normal calcium level: 8.6 mg/dL to 10.0 (<8.6 mg/dL)

Role of Calcium: plays a huge role in bone and teeth health along with muscle/nerve function, cell, and
blood clotting. Calcium is absorbed in the GI system and stored in the bones and then excreted by the
kidneys.

Vitamin D helps play a role in calcium absorption.

In addition, phosphorus and calcium affect each other in the opposite way. For instance, if
phosphorus levels are high in the blood, calcium will decrease and vice versa. They are always doing the
opposite (remember this because it is important for the causes of hypocalcemia.

Causes of Hypocalcemia

Remember “Low Calcium”

Low parathyroid hormone due. This is due to the destruction or removal parathyroid gland (any surgeries
of the neck ex: thyroidectomy you want to check the calcium level) Professors love to ask this on an
exam.

Oral intake inadequate (alcoholism, bulimia etc.)

Wound drainage (especially GI System because this is where calcium is absorbed)

Celiac’s & Crohn’s Disease cause malabsorption of calcium in the GI track

Acute Pancreatitis

Low Vitamin D levels (allows for calcium to be reabsorbed)

Chronic kidney issues (excessive excretion of calcium by the kidneys)

Increased phosphorus levels in the blood (phosphorus and calcium do the opposite of each other)

Using medications such as magnesium supplements, laxatives, loop diuretics, calcium binder drugs

Mobility issues

Signs & Symptoms of Hypocalcemia

Remember “CRAMPS”

Confusion

Reflexes hyperactive

Arrhythmias (prolonged QT interval and ST interval) Note: definitely remember prolonged QT interval…

another major test question

Muscle spasms in calves or feet, tetany, seizures

Positive Trousseau’s! You will see this before Chvostek’s sign or before tetany. This sign may be positive
before other manifestations of hypocalcemia such as hyperactive reflexes.

(KNOW How to elicit a positive Trousseau’s. You do this by using a blood pressure cuff and place it
around the upper arm and inflate it to a pressure greater than the systolic blood pressure and hold it in
place for 3 minutes. If it is positive the hand of the arm where the blood pressure is being taken will start
to contract involuntarily (see the teaching tutorial on a demonstration).

Signs of Chvostek’s (nerve hyperexcitability of the facial nerves. To elicit this response you would tap at
the angle of the jaw via the masseter muscle and the facial muscles on the same side of the face will
contract momentarily (the lips or nose will twitch).

Nursing Interventions for Hypocalcemia

 Safety (prevent falls because patient is at risk for bone fractures, seizures precautions, and watch
for laryngeal spasms)
 Administer IV calcium as ordered (ex: 10% calcium gluconate)….give slowly as ordered (be on
cardiac monitor and watch for cardiac dysrhythmias). Assess for infiltration or phlebitis because it
can cause tissue sloughing (best to give via a central line). Also, watch if patient is on Digoxin
cause this can cause Digoxin toxicity.
 Administer oral calcium with Vitamin D supplements (given after meals or at bedtime with a full
glass of water)
 If phosphorus level is high (remember phosphorus and calcium do the opposite) the doctor may
order aluminum hydroxide antacids (Tums) to decrease phosphorus level which in turn would
increase calcium levels.
 Encourage intake of foods high in calcium:
Young Sally’s calcium serum continues to randomly mess-up.

 Yogurt
 Sardines
  Cheese
 Spinach
 Collard greens
 Tofu
 Rhubarb
 Milk

Hypercalcemia

Hyper: excessive

Calc: prefix for calcium

Emia: blood

Meaning of Hypercalcemia: excessive calcium in the blood

Normal calcium levels in the blood: 8.6 to 10.0 mg/dL (>10.0 is hypercalcemia)

Calcium plays a huge role in bone and teeth health along with muscle/nerve function, cell, and blood
clotting.

Calcium is absorbed in the GI system and stored in the bones and then excreted by the kidneys.

Vitamin D helps play a role calcium absorption.

Causes of Hypercalcemia

Remember “High Cal”

Hyperparathyroidism (high parathyroid hormone causes too much calcium to be released into the blood)

Increased intake of calcium (excessive use of oral calcium or Vitamin D supplements)

Glucocorticoids usage (suppresses calcium absorption which leaves more calcium in the blood)

Hyperthyroidism

Calcium excretion decreased with Thiazide* diuretics & renal failure, cancer of the bones

Adrenal insufficiency (Addison’s Disease)

Lithium usage (affects the parathyroid and causes phosphate to decrease and calcium to increase)

Signs & Symptoms of Hypercalcemia

“The body is too WEAK”

Weakness of muscles (profound)

EKG changes shortened QT interval (most common) and prolonged PR interval

Absent reflexes, absent minded (disorientated), abdominal distention from constipation

Kidney Stone formation

Nursing Interventions for Hypercalcemia

Mild cases of Hypercalcemia

 Keep patient hydrated (decrease chance of renal stone formation)

 Keep patient safe from falls or injury
 Monitor cardiac, GI, renal, neuro status
 Assess for complaints of flank or abdominal pain & strain urine to look for stone formation
 Decrease calcium rich foods and intake of calcium-preserving drugs like thiazides, supplements,
Vitamin D
To help you remember foods high in calcium remember the phrase:

“Young Sally’s calcium serum continues to randomly mess-up”

Yogurt

Sardines

Cheese

Spinach

Collard greens

Tofu

Rhubarb

Milk

Moderate cases of Hypercalcemia

Administer calcium reabsorption inhibitors: Calcitonin, Bisphosphonates, prostaglandin synthesis

inhibitors (ASA, NSAIDS)

Severe cases of Hypercalcemia

Prepare patient for dialysis

Quiz on Hypocalcemia & Hypercalcemia

Which of the following is not a cause of hypocalcemia?

A) Low parathyroid hormone

B) Crohn’s Disease

C) Acute Pancreatitis

D) Thiazide Diuretics

A patient with Celica’s disease is at risk for which of the following?

A) Hypokalemia

B) Hypocalcemia

c) Hypomagnesemia

D) Hypercalcemia

Stimulation of the facial nerve via the masseter muscle causes twitching of the nose/lips in hypocalcemia
is known as?

A) Trousseau’s Sign

B) Chvostek’s Sign

C) Homan’s Sign

D) Goodell’s Sign

A patient’s calcium level is 6.9. Which of the following is a nursing priority?

A) Initiate seizure precautions

B) Educate patient about foods rich in calcium

C) Administer Calcitonin

D) Administer Vitamin D supplements as ordered

A patient has a calcium level of 7.2. What sign below is indicative of this lab value?

A)     None this is a normal calcium level

B)      Prolonged QT interval on the EKG

C)      Hypoactive bowel sounds

D)     Shortened ST segment

A patient’s lab work shows that they have a high parathyroid hormone level. Which of the following
conditions is the patient at risk for?

A) Hypercalcemia

B) Hypocalcemia

C) Hypokalemia

D) Hyperkalemia

A patient’s calcium level is 11.2. Which of the following conditions could be the cause?

A) None, 11.2 is a normal calcium level

B) Hydrochlorothiazide

C) Cushing’s Syndrome

D) Hypoparathyroidism

Lithium is known to affect the parathyroid by increasing ______ levels and decreasing _____ levels?

A) calcium, phosphate

B) phosphate, calcium

C) calcium, sodium

D) sodium, calcium

An EKG shows a shortened QT interval. Which of the following lab values would be indicative of this
change?

A) Calcium level of 8.0

B) Calcium level of 12.0

C) Calcium level of 8.7

D) Calcium level of 9.2

A patient has a calcium level of 12.5. Which medication will most likely be ordered for this patient?

A) Calcitonin

B) 10% Calcium Gluconate

C) Calcium Chloride

D) Hydrochlorothiazide
A patient is being discharged home after hospitalization for hypocalcemia. Which statement by the patient
indicates she understood the dietary instructions?

A) “I will avoid sardines.”

B) “I’ll avoid salt and Vitamin-D supplements.”

C) “I will tell my husband to only purchase skim milk.”

D) “I will be sure to eat lots of cheese, tofu and spinach.”

A patient is recovering from parathyroid surgery. Morning labs values are back. Which of the following lab
values would correlate as a complication from this type of surgery?

A)     Calcium 6.9

B)      Calcium 12.5

C)      Calcium 8.7

D)     Calcium 9.2

Answer Key:
D
B
B
A
B
A
B
A
B
A
D
A