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.
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