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Definition

Hypocalcemia is a lower level of calcium in the blood than is normal. Calcium is a mineral that is needed for bone health, muscle movement, and healthy nerves.

Causes

An illness or treatment can change how the body absorbs, balances, or keeps calcium. This can lead to hypocalcemia. Calcium levels in the body are affected by a number of things such as:

  • Vitamin D levels—needed to help absorb calcium from food or supplements
  • Kidney function—controls how much calcium is removed from the body
  • Hormones, especially those controlled by parathyroid gland—can affect levels of calcium in the blood

Risk Factors

Factors that may interfere with hormones, which can lead to hypocalcemia include:

  • Parathyroid problems
  • Previous thyroid surgery
  • Autoimmune diseases
  • Certain types of brain cancer
  • Genetic disorders

Factors that may make it harder to get calcium into your body:

  • Lack of vitamin D in the diet or through sunlight exposure
  • Lack of magnesium in the diet
  • Digestive problems such as inflammatory bowel disease
  • Certain medications such as diuretics or laxatives

Other factors that may increase the chances of hypocalcemia:

  • Inflammation of the pancreas—pancreatitis
  • Kidney disease or failure—too much calcium excreted [most common cause]
  • Certain medications such as bisphosphonates—move calcium to the bones
Kidney Damage
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Symptoms

Early hypocalcemia may not have any symptoms. When symptoms do occur, they may include:

  • Fatigue
  • Muscle spasms
  • Tingling and numbness
  • Irregular heartbeat
  • Skin changes such as dry, scaly skin
  • Coarse hair that easily breaks
  • Difficulty breathing in newborns

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done. Blood tests will show the level of calcium.

Other tests that may be done to look for causes or complications include:

  • Urine tests
  • X-rays
  • ECG to test the electrical activity of the heart

Treatment

The goal of treatment is to get calcium back to normal levels. Underlying causes may need to be treated first.

Supplements may be given through an IV or with pills. Supplements may include:

  • Calcium
  • Vitamin D
  • Magnesium

Your doctor may also advise you to increase your intake of calcium and vitamin D. You may be referred to a dietitian.

Prevention

To help reduce the chance of hypocalcemia:

  • Eat a diet that contains enough calcium and vitamin D. This is especially important during pregnancy.
  • Take calcium or vitamin D supplements if advised by your doctor.
  • Manage related conditions, such as chronic kidney disease and hypoparathyroidism.

RESOURCES

Family Doctor—American Academy of Family Physicians  https://www.familydoctor.org 

The American Association of Clinical Endocrinologists  https://www.aace.com 

CANADIAN RESOURCES

Health Canada  https://www.canada.ca 

The Canadian Society of Endocrinology and Metabolism  http://www.endo-metab.ca 

References

Cooper M, Gittoes N. Diagnosis and management of hypocalcaemia. BMJ. 2008;336(7656):1298-1302.

Hypocalcemia. EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T115897/Hypocalcemia  . Updated June 27, 2017. Accessed March 26, 2018.

Hypocalcaemia. Patient website. Available at: https://patient.info/doctor/hypocalcaemia. Updated December 23, 2015. Accessed March 26, 2018.

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