Hypocalcemia: Causes, Symptoms & Treatment (2023)

Overview

What is hypocalcemia?

Hypocalcemia is a treatable condition that happens when the levels of calcium in your blood are too low.

Many different health conditions can cause hypocalcemia, and it’s often caused by abnormal levels of parathyroid hormone (PTH) or vitamin D in your body. Hypocalcemia can be mild or severe and temporary or chronic (lifelong).

What is calcium and what does it do?

Calcium is one of the most important and common minerals in your body. Most of your body’s calcium is stored in your bones, but calcium is needed in your blood as well.

The calcium in your blood helps your nerves work, helps make your muscles squeeze together so you can move, helps your blood clot if you are bleeding and helps your heart work properly. A low level of calcium in your blood (hypocalcemia) can hinder your body’s ability to perform these important functions. You also need calcium in your bones to make them strong.

If you don’t consume enough calcium in your diet, your body takes calcium from your bones to use in your blood, which can weaken your bones. Hypocalcemia happens when there are low levels of calcium in your blood, not your bones.

The levels of calcium in your blood and bones are controlled by two hormones called parathyroid hormone and calcitonin. Vitamin D also plays an important role in maintaining calcium levels because it’s needed for your body to absorb calcium.

(Video) Hypocalcemia - causes, symptoms, diagnosis, treatment, pathology

Who gets hypocalcemia?

Hypocalcemia can affect people of all ages, including infants. The age at which someone could develop hypocalcemia usually depends on the cause. For example, if an infant has hypocalcemia, it’s often because of a genetic disorder.

How common is hypocalcemia?

Healthcare professionals and researchers have not yet determined how common hypocalcemia is. This is likely because hypocalcemia is usually a side effect of other health issues.

Hypocalcemia is a common side effect of having your thyroid removed (thyroidectomy). Approximately 7% to 49% of people have temporary hypocalcemia after thyroidectomy.

Symptoms and Causes

What are the symptoms of hypocalcemia?

People who have mild hypocalcemia often have no symptoms (are asymptomatic). The symptoms of hypocalcemia depend on if it’s mild or severe.

Symptoms of mild hypocalcemia can include:

  • Muscle cramps, especially in your back and legs.
  • Dry, scaly skin.
  • Brittle nails.
  • More coarse hair than what’s normal for you.

If left untreated, over time hypocalcemia can cause neurologic (affecting the nervous system) or psychologic (affecting the mind) symptoms, including:

(Video) Hypocalcemia (Low Calcium) Pathology, Causes, Symptoms and Treatment, Animation

  • Confusion.
  • Memory problems.
  • Irritability or restlessness.
  • Depression.
  • Hallucinations.

Severe hypocalcemia (very low levels of calcium in your blood) can cause the following symptoms:

  • Tingling in your lips, tongue, fingers and/or feet.
  • Muscle aches.
  • Muscle spasms in your throat that make it difficult to breathe (laryngospasm).
  • Stiffening and spasms of your muscles (tetany).
  • Seizures.
  • Abnormal heart rhythms (arrhythmia).
  • Congestive heart failure.

What causes hypocalcemia?

There are many complex functions and factors involved with maintaining a steady level of calcium in your blood and body. Because of this, several different health conditions and disorders can cause hypocalcemia.

Most of the time, an issue with your parathyroid hormone (PTH) levels and/or vitamin D level(s) is involved with the cause of hypocalcemia. This is because PTH helps control the level of calcium in your blood and vitamin D helps your body absorb calcium.

The three most common causes of hypocalcemia include:

  • Hypoparathyroidism: Hypoparathyroidism happens when your parathyroid glands (four small pea-sized glands behind your thyroid in your neck) don’t make enough parathyroid hormone (PTH). Low levels of PTH cause low levels of calcium in your body. You can have hypoparathyroidism from an inherited disorder or from having one or more of your parathyroid glands or your thyroid gland surgically removed.
  • Vitamin D deficiency: Vitamin D helps your body absorb calcium properly, so a lack of vitamin D in the body can cause low levels of calcium in your blood (hypocalcemia). Vitamin D deficiency can be caused by an inherited disorder or by not getting enough sunlight or not consuming enough vitamin D.
  • Kidney failure (renal failure): Hypocalcemia in chronic renal failure is due to an increased level of phosphorus in your blood and decreased renal production of a certain kind of vitamin D.

Other causes of hypocalcemia include:

  • Certain medications: Bisphosphonates, corticosteroids, rifampin, calcitonin, chloroquine, cinacalcet, Denosumab, Foscarnet and plicamycin can all cause hypocalcemia.
  • Pseudohypoparathyroidism: This is an inherited disorder that causes your body to not respond properly to the normal amount of parathyroid hormone (PTH) it has. Your body acts like it doesn’t have enough PTH when it actually has normal levels of PTH.
  • Hypomagnesemia: Your parathyroid glands need magnesium to make and release parathyroid hormone (PTH), so when your magnesium is too low (hypomagnesemia), not enough PTH is produced and blood calcium levels are also lower (hypocalcemia).
  • Pancreatitis: Approximately 15% to 88% of people who have acute pancreatitis will have hypocalcemia.
  • Certain rare genetic disorders: Genetic mutations, such as DiGeorge syndrome, can cause hypocalcemia.

Diagnosis and Tests

How is hypocalcemia diagnosed?

You have hypocalcemia if your total serum (blood) calcium concentration is less than 8.8 mg/dL. Your healthcare provider may find mild hypocalcemia incidentally (by chance) from routine blood tests or by testing for other conditions.

(Video) Hypercalcemia - causes, symptoms, diagnosis, treatment, pathology

What tests will be done to diagnose the cause of hypocalcemia?

Healthcare providers use a calcium concentration blood test to diagnose hypocalcemia. Figuring out and diagnosing the cause of hypocalcemia is just as important as diagnosing the hypocalcemia itself.

Your healthcare provider may perform the following tests or procedures to try to determine the cause of your hypocalcemia or to be sure your hypocalcemia isn’t affecting other parts of your body:

  • Other blood tests: Your healthcare provider may do more blood tests to check your levels of magnesium, phosphorus, parathyroid hormone (PTH) and/or vitamin D.
  • EKG (electrocardiogram): An EKG is a procedure that uses electrodes attached to your chest to measure your heart rhythm. Hypocalcemia can cause an abnormal heart rhythm.
  • Bone imaging tests: Bone imaging tests could be used to see if you have calcium issues in your bones, such as osteomalacia or rickets.

Management and Treatment

How is hypocalcemia treated?

Oral calcium supplements are the most common treatment for hypocalcemia. Treating the cause of hypocalcemia is just as important as treating the hypocalcemia itself. If you’re taking a medication that is causing your hypocalcemia, your healthcare provider may change it or adjust it in order to return your calcium levels to normal.

What medications and treatments are used for hypocalcemia?

The following treatments and medications are often used for hypocalcemia:

  • Oral calcium pills: Calcium pills or supplements may be used to restore your calcium to normal levels.
  • Vitamin D supplement: People who have chronic hypocalcemia often take a vitamin D supplement along with calcium pills so that their bodies can properly absorb the calcium.
  • Synthetic form of parathyroid hormone (PTH): If you have hypoparathyroidism that is causing hypocalcemia, your healthcare provider may have you take a synthetic form of PTH.
  • IV calcium gluconate: If your hypocalcemia is severe and you are experiencing muscle cramps or spasms (tetany), you may receive an IV of calcium gluconate in the hospital.
  • Other medications: Depending on the cause of your hypocalcemia, you may have to take other medications to treat/and or manage the cause.

Prevention

What are the risk factors for hypocalcemia?

Risk factors for developing hypocalcemia can include having:

(Video) Hypocalcemia: Symptoms

  • Vitamin D deficiency.
  • A parathyroid disorder or parathyroid gland surgery.
  • Thyroid removal surgery (thyroidectomy).
  • A family history of genetic conditions such as certain genetic mutations, genetic vitamin D disorder or DiGeorge syndrome.

Can I prevent hypocalcemia?

Unfortunately, there’s nothing you can do to prevent hypocalcemia. Although it may seem that eating and drinking more calcium could prevent hypocalcemia, a lack of calcium in your diet usually doesn’t affect the amount of calcium in your blood. Maintaining adequate calcium intake, however, is important for bone health.

Outlook / Prognosis

What is the prognosis (outlook) for hypocalcemia?

Hypocalcemia is a treatable condition. Symptoms of hypocalcemia usually go away once your calcium levels are back to normal. If left untreated, severe hypocalcemia can cause life-threatening complications such as seizures and congestive heart failure. Be sure to contact your healthcare provider if you’re experiencing symptoms and go to the nearest hospital if you are experiencing severe symptoms.

How long will I have hypocalcemia?

Depending on the cause, you could have temporary or chronic (lifelong) hypocalcemia. Ask your healthcare provider how long you can expect to have hypocalcemia and how long you’ll have to take medication.

Can I die from hypocalcemia?

Hypocalcemia can be potentially life-threatening if it’s not diagnosed and treated in time. Be sure to contact your healthcare provider if you’re experiencing symptoms.

Living With

When should I see my healthcare provider?

Be sure to contact your healthcare provider if you’re experiencing symptoms of hypocalcemia. If you have chronic hypocalcemia, it’s important to see your healthcare provider regularly so that you can be sure your calcium levels are healthy and that your treatment is working.

(Video) Hypocalcemia: Treatment

What questions should I ask my doctor if I have hypocalcemia?

If you’ve been diagnosed with hypocalcemia, it may be helpful to ask your healthcare provider the following questions:

  • What caused my hypocalcemia?
  • How long will I have hypocalcemia?
  • How long will I have to take medication for my hypocalcemia?
  • When will my symptoms go away once I start my medication for hypocalcemia?
  • Are my children or family members at risk of developing hypocalcemia?

A note from Cleveland Clinic

Getting a diagnosis can be scary. Know that hypocalcemia is treatable and that symptoms usually go away once your calcium levels are back to normal with treatment. Don’t be afraid to ask your healthcare team questions about your hypocalcemia and its management.

FAQs

What are the cause of hypocalcemia? ›

Causes of hypocalcemia include hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency, and renal failure. Mild hypocalcemia may be asymptomatic or cause muscle cramps.

How is hypocalcemia treated? ›

In patients with acute symptomatic hypocalcemia, intravenous (IV) calcium gluconate is the preferred therapy, whereas chronic hypocalcemia is treated with oral calcium and vitamin D supplements.

What problems can hypocalcemia cause? ›

Muscle cramps involving the back and legs are common. Over time, hypocalcemia can affect the brain and cause neurologic or psychologic symptoms, such as confusion, memory loss, delirium, depression, and hallucinations. These symptoms disappear if the calcium level is restored.

What medications cause hypocalcemia? ›

Certain medications.

Drugs like rifampin (an antibiotic), and phenytoin and phenobarbital (anti-seizure drugs) can cause this. Additionally, medicines that fight bone cancers and other bone issues are also linked with hypocalcemia. These drugs include alendronate, ibandronate, risedronate, and zoledronic acid.

Is hypocalcemia a disease? ›

Hypocalcemia, also known as calcium deficiency disease, occurs when the blood has low levels of calcium. A long-term calcium deficiency can lead to dental changes, cataracts, alterations in the brain, and osteoporosis, which causes the bones to become brittle.

What are symptoms of low calcium in the blood? ›

Symptoms of low blood calcium
  • painful muscle spasms and cramps.
  • twitching of muscles.
  • numbness or tingling in feet and hands.
  • numbness or tingling around the mouth.

Who is at risk for hypocalcemia? ›

Who is at risk for hypocalcemia? People with a vitamin D or magnesium deficiency are at risk of hypocalcemia. Other risk factors include: a history of gastrointestinal disorders.

Can hypocalcemia be cured? ›

Hypocalcemia is a treatable condition. Symptoms of hypocalcemia usually go away once your calcium levels are back to normal. If left untreated, severe hypocalcemia can cause life-threatening complications such as seizures and congestive heart failure.

How long does it take to recover from hypocalcemia? ›

You can expect to see results within the first few weeks of treatment. Severe cases of calcium deficiency disease will be monitored at one- to three-month intervals.

What cancers cause low calcium levels? ›

Hypocalcemia is associated with several types of cancer, but is more frequent in hematological, colorectal, lung, and thyroid cancers. A low calcium level measured at some point in a patient with cancer seems to not be significantly associated with lower survival.

Can hypocalcemia cause muscle weakness? ›

Low levels of calcium commonly cause extreme tiredness, or fatigue, and generalized muscle weakness. This symptom can affect patients' ability to complete everyday tasks.

What is severe hypocalcemia? ›

Severe hypocalcemia, defined by a serum calcium <1.9 mmol/L (7.6 mg/dL), is often considered an emergency because of a potential risk of life-threatening cardiac arrhythmias or seizures (6, 7, 8, 9, 10, 11).

How is hypocalcemia diagnosed? ›

Hypocalcemia is diagnosed by a total serum calcium concentration < 8.8 mg/dL (< 2.2 mmol/L). However, because low plasma protein can lower total, but not ionized, serum calcium, ionized calcium should be estimated based on albumin concentration.

What is the test for calcium deficiency? ›

A total calcium test is the most common test for blood calcium. It's often part of a basic metabolic panel (BMP) and a comprehensive metabolic panel (CMP), which are both routine screening tests. An ionized calcium test measures only the "free calcium" in your blood that isn't attached to proteins.

How can I increase my calcium level? ›

Calcium and diet

Dairy products, such as cheese, milk and yogurt. Dark green leafy vegetables, such as broccoli and kale. Fish with edible soft bones, such as sardines and canned salmon. Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes.

Does hypocalcemia cause heart block? ›

Hypocalcemia typically prolongs the Q-T interval on electrocardiograms and may lead to complete heart block. Other signs and symptoms include mental status changes, tetany, laryngospasm, Chvostek (facial nerve) and Trousseau (brachial artery occlusion) signs, hypotension, and arrhythmias.

Can low calcium cause back pain? ›

Dietary Calcium Deficiency

This increases the risk of fractures and can also cause a “humped” back. The symptoms of this type of Calcium deficiency are: Bone pain or tenderness. Back or neck pain.

When should hypocalcemia be corrected? ›

Patients with severe symptoms of hypocalcemia such as carpopedal spasm, tetany, seizures, decreased cardiac function, or prolonged QT interval need IV calcium replacement to rapidly correct their hypocalcemia. Treat all asymptomatic patients with an acute decrease in serum corrected calcium to ≤7.5 mg/dL (1.9 mmol/L).

How does low calcium affect the heart? ›

Having too little calcium has been linked with heart failure, low blood pressure (hypotension) and lifethreatening rhythm disorders of the heart, said Chaudhary. “In the long term, inadequate calcium intake causes osteopenia which, if untreated, can lead to osteoporosis.

What is normal calcium level? ›

Normal Results

Normal values range from 8.5 to 10.2 mg/dL (2.13 to 2.55 millimol/L). Normal value ranges may vary slightly among different laboratories. Some laboratories use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.

Which food has high calcium? ›

Sources of calcium

milk, cheese and other dairy foods. green leafy vegetables – such as curly kale, okra but not spinach (spinach does contain high levels of calcium but the body cannot digest it all) soya drinks with added calcium. bread and anything made with fortified flour.

Does calcium affect the brain? ›

Calcium also contributes to healthy brain development. It regulates the development of neurons and impacts both structural makeup of brain cells and their ability to function.

How do you prevent hypocalcemia? ›

How is Hypocalcemia prevented? It is better to prevent the deficiency of calcium in the body than to treat it. This can be done by ensuring that an individual consumes calcium-rich foods regularly such as cheese, yogurt, almonds, etc. Also, ensure to add supplements of vitamin D and magnesium.

What are two signs of hypocalcemia? ›

Symptoms of hypocalcemia most commonly include paresthesia, muscle spasms, cramps, tetany, circumoral numbness, and seizures.

What causes calcium deficiency in adults? ›

Vitamin D deficiency, low parathyroid gland function, gut disorders, and kidney disease are among the more common causes of hypocalcemia. Rarely, you can become deficient if you're not getting enough dietary calcium. Work with your doctor if your calcium levels are low to discover and treat the underlying cause.

What causes calcium deficiency in adults? ›

Vitamin D deficiency, low parathyroid gland function, gut disorders, and kidney disease are among the more common causes of hypocalcemia. Rarely, you can become deficient if you're not getting enough dietary calcium. Work with your doctor if your calcium levels are low to discover and treat the underlying cause.

Who is most at risk for hypocalcemia? ›

Who is at risk for hypocalcemia? People with a vitamin D or magnesium deficiency are at risk of hypocalcemia. Other risk factors include: a history of gastrointestinal disorders.

What can cause hypercalcemia? ›

Hypercalcemia is usually a result of overactive parathyroid glands. These four tiny glands are situated in the neck, near the thyroid gland. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements.

Who is most at risk for calcium deficiency? ›

People with lactose intolerance, those with an allergy to milk, and those who avoid eating dairy products (including vegans) have a higher risk of inadequate calcium intakes because dairy products are rich sources of calcium [1,27].

Is hypocalcemia curable? ›

Hypocalcemia is a treatable condition. Symptoms of hypocalcemia usually go away once your calcium levels are back to normal. If left untreated, severe hypocalcemia can cause life-threatening complications such as seizures and congestive heart failure.

What is the test for calcium deficiency? ›

A total calcium test is the most common test for blood calcium. It's often part of a basic metabolic panel (BMP) and a comprehensive metabolic panel (CMP), which are both routine screening tests. An ionized calcium test measures only the "free calcium" in your blood that isn't attached to proteins.

How is hypocalcemia diagnosed? ›

Hypocalcemia is diagnosed by a total serum calcium concentration < 8.8 mg/dL (< 2.2 mmol/L). However, because low plasma protein can lower total, but not ionized, serum calcium, ionized calcium should be estimated based on albumin concentration.

What are two signs of hypocalcemia? ›

What are the symptoms of hypocalcemia?
  • confusion or memory loss.
  • muscle spasms.
  • numbness and tingling in the hands, feet, and face.
  • depression.
  • hallucinations.
  • muscle cramps.
  • weak and brittle nails.
  • easy fracturing of the bones.

Does calcium affect the brain? ›

Calcium also contributes to healthy brain development. It regulates the development of neurons and impacts both structural makeup of brain cells and their ability to function.

Can hypocalcemia cause muscle weakness? ›

Low levels of calcium commonly cause extreme tiredness, or fatigue, and generalized muscle weakness. This symptom can affect patients' ability to complete everyday tasks.

What is the most common treatment for hypercalcemia? ›

Pamidronate is the most commonly used medication for the treatment of hypercalcemia. It is given by IV infusion over 4 to 24 hours. The initial dose varies: 30 mg if the calcium level is lower than 12 mg/dL, 60 mg if the calcium level is 12 to 13.5 mg/dL, and 90 mg if the calcium level is above that level.

What is normal calcium level? ›

Normal Results

Normal values range from 8.5 to 10.2 mg/dL (2.13 to 2.55 millimol/L). Normal value ranges may vary slightly among different laboratories. Some laboratories use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results.

What is the first line treatment for hypercalcemia? ›

Intravenous bisphosphonates are the treatment of first choice for the initial management of hypercalcaemia, followed by continued oral, or repeated intravenous bisphosphonates to prevent relapse.

What cancers cause low calcium? ›

Hypocalcemia is associated with several types of cancer, but is more frequent in hematological, colorectal, lung, and thyroid cancers. A low calcium level measured at some point in a patient with cancer seems to not be significantly associated with lower survival.

What is the best source of calcium? ›

Fruits, leafy greens, beans, nuts, and some starchy vegetables are good sources.
  • Cheese.
  • Yogurt.
  • Calcium-fortified orange juice.
  • Winter squash.
  • Edamame (young green soybeans); Tofu, made with calcium sulfate.
  • Canned sardines, salmon (with bones)
  • Almonds.
  • Leafy greens (collard, mustard, turnip, kale, bok choy, spinach)

Can low calcium affect eyesight? ›

Cataracts – cataracts that develop and cause blurry vision can also be caused by calcium deficiency. Lack of calcium don't just affect the bones but also affect your nervous system and organs such as the eyes.

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