Fluid Electrolyte imbalance: Calcium
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Calcium 4.5-5.5 mEq/L Function: nerve & muscle contraction, cardiac function, clotting. |
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Hypocalcemia |
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Values: |
<4.5 mEq/L |
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Causes: |
· Most common: depressed function or surgical removal of parathyroid gland · Hypomagnesemia · Hyperphosphatemia · Administration of large quantities of stored blood (preserved with citrate) · Renal insufficiency · ↓absorption of Vit D from intestines
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Signs and symptoms: |
· Abdominal and/or extremity cramping · Tingling and numbness · +Chvostek or Trousseau signs · Tetany (hyperactive reflexes) · Irritability, reduced cognitive ability, seizures · Prolonged QT on ECG, hypotension, decreased myocardial contractility · Abnormal clotting
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Treatment: |
· High Calcium diet or oral calcium salt (check for calcium content) · IV calcium as 10% calcium chloride or 10% calcium gluconate (give with caution) · Close monitoring of serum Ca and digitalis levels · ↓Phosphorus levels and ↑Magnesium levels · Vitamin D therapy
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Hypercalcemia |
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Values: |
>5.5 mEq/L |
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Causes: |
· Mobilization of Ca from bone · Malignancy · Hyperparathyroidism · Immobilization – cause of bone loss · Thiazide diuretics · Thyrotoxicosis · Excessive ingestion of Calcium or Vit. D |
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Signs and symptoms: |
· Anorexia, constipation · Generalized muscle weakness, lethargy, loss of muscle tone, ataxia · Depression, fatigue, confusion, coma · Dysrythmias and heart block · Deep bone pain and demineralization · Polyuria & predisposes to renal calculi · Pathologic bone fractures
*Hypercalcemic crisis: 8-9 mEq/L
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Treatment: |
· NS IV – match infusion rate t amount of UOP · I&O hourly · Loop diuretics · Corticosteroids and mithramycin in cancer patients · Phosphorous / calcitonin · Encourage fluids · Keep urine acid |