Hypocalcemia: Difference between revisions

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{{ICD10 Guideline repeated events}}
{{ICD10 Guideline repeated events}}
=== Thresholds for pts with regular albumin levels ===
=== Thresholds for pts with regular albumin levels ===
*The parameters for coding hypocalcemia are any of the following 3 items:  (This change is active as of Feb 12, 2018)
*The parameter for coding hypocalcemia (using total serum calcium) is the following:  (This change is active as of Feb 12, 2018)
**'''Ca++ < 1.8 '''OR'''
**'''Ca++ <= 1.8  
**'''Any Ca++ < 2.2 AND in the presence of signs or symptoms believed to be due to hypocalcemia''' '''OR'''
**'''Any Ca++ < 2.2 with active treatment for hypocalcemia '''


=== Thresholds for pts with hypoalbuminemia  ===
=== Thresholds for pts with hypoalbuminemia  ===
For patients with substantial hypoalbuminemia using total calcium to define hypcalcemia is a problem.
For patients with substantial hypoalbuminemia using total calcium to define hypocalcemia is a problem.
* These cutoff numbers are all 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.
* 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.
**So to diagnose ionized hypocalcemia use these thresholds for ionized (not total) serum calcium:
**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'''
***'''Ca++ <0.9 regardless, OR <1.15 with symptoms or being treated for it'''

Revision as of 17:37, 27 February 2025

ICD10 Diagnosis
Dx: Hypocalcemia
ICD10 code: E83.51
Pre-ICD10 counterpart: Hypocalcemia Ca Less Than 1.8
Charlson/ALERT Scale: none
APACHE Como Component: none
APACHE Acute Component: 2019-0: Metabolic/Renal NOS, 2019-0: Renal/Metabolic NOS
Start Date:
Stop Date:
Data Dependencies(Reports/Indicators/Data Elements): No results
External ICD10 Documentation

This diagnosis is a part of ICD10 collection.

  • SMW
    • 2019-01-01
    • 2999-12-31
    • E83.51
  • Cargo


  • Categories
  • SMW
  • Cargo


  • Categories
  • SMW
  • Cargo


  • Categories

Additional Info

Repeated events

If this happens repeatedly during the same ward or unit stay, only code it the first time it happens, regardless of whether it is an Admit Diagnosis or Acquired Diagnosis, rather than each time it happens. See ICD10 codes only coded the first time for other diagnoses coded this way.

Example:   
  • A person has a self-limited episode of A-fib. It goes away and then recurs. Only code the first one.
  • A person has a self-limited episode of A-fib. It goes away but then he has an episode of V-tach. As this is a different diagnosis, both of these should be listed, but only code once each.
  • Patient comes in with hypokalemia. It’s treated and remits, but the next day it recurs. Only code the first time.

Thresholds for pts with regular albumin levels

  • The parameter for coding hypocalcemia (using total serum calcium) is the following: (This change is active as of Feb 12, 2018)
    • Ca++ <= 1.8

Thresholds for pts with hypoalbuminemia

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.
    • 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

Signs and symptoms

  • Main signs and symptoms of hypocalcemia 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

Alternate ICD10s to consider coding instead or in addition

Candidate Combined ICD10 codes

Related CCI Codes

Data Integrity Checks (automatic list)

none found

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