Hypocalcemia: Difference between revisions

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=== Thresholds for pts with regular albumin levels ===

*The ~~parameters~~ for coding ~~hypocalcemia (using total serum calcium)~~ are ~~the following~~:

*The criteria for coding this is are either:

**Ca++ <= 1.8

**Ca++ <= 1.8 -- but as below, this is only reliable for those with albumin >= 3.0

** ionized Ca++ <=0.8

**ionized Ca++ <=0.8

=== Thresholds for pts with hypoalbuminemia ===

For patients with substantial hypoalbuminemia using total calcium to define hypocalcemia is a problem.

*For patients with substantial hypoalbuminemia using total calcium to define hypocalcemia is a problem.

* ~~The above parameter is used for total serum calcium. But it~~'s actually the ionized serum calcium that's relevant and causes symptoms when high or low -- AND the usual range for total calcium is altered (downwards) in patients with low serum albumin. So you can have a completely normal ionized calcium with a very low total calcium if the albumin is significantly low. Furthermore, the old "correction" of total calcium for measured albumin does not work well ~~at all~~. Thus, to identify truly low circulating calcium in the presence of more than trivial hypoalbuminemia, it's necessary to ~~measure an~~ ionized calcium.

* It's actually the ionized serum calcium that's relevant and causes symptoms when high or low -- AND the usual range for total calcium is altered (downwards) in patients with low serum albumin. So you can have a completely normal ionized calcium with a very low total calcium if the albumin is significantly low. Furthermore, the old "correction" of total calcium for measured albumin does not work well. Thus, to identify truly low circulating calcium in the presence of more than trivial hypoalbuminemia, it's necessary to use measurement of ionized calcium, using the threshold (as above) of ionized Ca++ <=0.8

**So to diagnose ionized hypocalcemia use these thresholds for ionized (~~not total~~) ~~serum calcium:~~

~~***~~Ca++ <0.~~9 regardless, OR <1.15 with symptoms or being treated for it'''~~

*~~Main~~ signs ~~and~~ symptoms of ~~hypocalcemia~~ are:

*Presence/absence of signs or symptoms are not part of the coding criterion, though they are:

**GI - nausea\vomiting, abdominal pain

**Neuromuscular - paresthesias (esp. acral, perioral), muscle cramps\spasms, hyperreflexia, tetany, weakness, fatigue, seizures, extrapyramidal movement disorders, abnormal EEG

**cardiovascular - long QT interval, hypotension (if acute), arrythmias

**~~miscellaneous~~ - secondary hypoparathyroidism

**Miscellaneous - secondary hypoparathyroidism

@@ Line 13: / Line 13: @@
 === Thresholds for pts with regular albumin levels ===
-*The parameters for coding hypocalcemia (using total serum calcium) are the following:
+*The criteria for coding this is are either:
-**Ca++ <= 1.8
+**Ca++ <= 1.8 -- but as below, this is only reliable for those with albumin >= 3.0
-** ionized Ca++ <=0.8
+**ionized Ca++ <=0.8
 === Thresholds for pts with hypoalbuminemia  ===
-For patients with substantial hypoalbuminemia using total calcium to define hypocalcemia is a problem.
+*For patients with substantial hypoalbuminemia using total calcium to define hypocalcemia is a problem.
-* The above parameter is used for total serum calcium. But it's actually the ionized serum calcium that's relevant and causes symptoms when high or low -- AND the usual range for total calcium is altered (downwards) in patients with low serum albumin.  So you can have a completely normal ionized calcium with a very low total calcium if the albumin is significantly low.  Furthermore, the old "correction" of total calcium for measured albumin does not work well at all.  Thus, to identify truly low circulating calcium in the presence of more than trivial hypoalbuminemia, it's necessary to measure an ionized calcium.
+* It's actually the ionized serum calcium that's relevant and causes symptoms when high or low -- AND the usual range for total calcium is altered (downwards) in patients with low serum albumin.  So you can have a completely normal ionized calcium with a very low total calcium if the albumin is significantly low.  Furthermore, the old "correction" of total calcium for measured albumin does not work well.  Thus, to identify truly low circulating calcium in the presence of more than trivial hypoalbuminemia, it's necessary to use measurement of ionized calcium, using the threshold (as above) of ionized Ca++ <=0.8
-**So to diagnose ionized hypocalcemia use these thresholds for ionized (not total) serum calcium:
-***Ca++ <0.9 regardless, OR <1.15 with symptoms or being treated for it'''
-*Main signs and symptoms of hypocalcemia are:
+*Presence/absence of signs or symptoms are not part of the coding criterion, though they are:
 **GI - nausea\vomiting, abdominal pain
 **Neuromuscular - paresthesias (esp. acral, perioral), muscle cramps\spasms, hyperreflexia, tetany, weakness, fatigue, seizures, extrapyramidal movement disorders, abnormal EEG
 **cardiovascular - long QT interval, hypotension (if acute), arrythmias
-**miscellaneous - secondary hypoparathyroidism
+**Miscellaneous - secondary hypoparathyroidism
 {{ICD10 Guideline Electrolytes}}