Approach

Low albumin-corrected serum total calcium with an inappropriately normal or frankly low plasma intact parathyroid hormone (PTH) level define the diagnosis. These patients should be further screened with a thorough clinical assessment for any signs or symptoms of hypocalcaemia, concomitant conditions and medications that could be altering calcium, magnesium, and PTH homeostasis, with special focus on prior neck surgery and inherited conditions.

If the presenting symptoms are severe and life-threatening, such as intractable tetany, laryngospasm, bronchospasm/wheezing, dyspnoea, altered mentation, seizures, cardiac failure, tachycardia, therapy should be immediate; treat with intravenous calcium infusion with close cardiac monitoring, clinical symptom monitoring, and repeated laboratory testing. Hypomagnesaemia should be considered for magnesium replacement if the serum levels of magnesium are reduced, as this can exacerbate hypocalcaemia and delay its recovery. The circumstances under which magnesium may be depleted include malabsorption, nutritional compromise, proton-pump inhibitor therapy, and acute and chronic alcohol intake.

BMJ Best Practice is an evidence-based point of care tool for healthcare practitioners.

To continue reading and access all of BMJ Best Practice's pages you'll need to log in or start a free trial.

You can access through your institution if your hospital, university, trust or other institution provides access to BMJ Best Practice through either OpenAthens or Shibboleth.

Use of this content is subject to our disclaimer