Hypocalcemia (calcium) Calculator - Corrected calcium level

Hypocalcemia (calcium) Calculator - Corrected calcium level

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Data Entry

Patient weight: kg Total calcium:

Serum albumin level:

Is the patient experiencing any of the following signs/symptoms due to hypocalcemia?
(tetany, carpopedal spasm, seizures, or prolongation of QT interval):

Is the patient experiencing any mild symptoms?: numbness with tingling of the finger or circumoral region (paresthesias) or other symptoms of neuromuscular irritability?

The current drop in calcium levels was due primarily to a:

Is the patient able to take and absorb oral calcium?:

Does the patient have chronic renal failure?

Is the patient currently taking digoxin?

Background - Hypocalcemia

Normal laboratory values (adult patients):
Calcium (Serum): 8.5 - 10.5 mg/dL (2.12 - 2.57 mmol/L )
Calcium (Ionized) Serum: 4.5 - 5.6 mg/dL (1.1-1.4 mmol/L)

Vitamin D and calcium requirements (RDA)

Calcium requirements (oral)

Vitamin D (RDA)

Calcium supplements:
http://www.globalrph.com/calcium_supplements.htm

Body Calcium

99% in bone.

1% in ECF:
[50% in its free ionized form]
[40% complexed with albumin]
[10% complexed with anions such as phosphate.]

Less than 1% of the body's calcium is contained within the ECF, yet this concentration is regulated carefully by the parathyroid hormone and calcitonin. Parathyroid hormone is released by the parathyroid gland in response to a low serum calcium level. It increases resorption of bone (movement of Ca++ and PO4 out of the bone); activates vitamin D, which increases the absorption of calcium from the GIT; and simultaneously stimulates the kidneys to conserve calcium and excrete phosphorus. Calcitonin is produced by the thyroid gland when serum calcium levels are elevated (inhibits bone resorption).
The ECF gains Ca++ from intestinal absorption and resorption from bones. It is lost from the ECF via secretion into the GIT, urinary excretion, and deposition into bone.

Calcium is present in 3 different forms in the plasma: ionized, bound and complexed. Only the ionized calcium is physiologically important. The percentage of calcium that is ionized is affected by pH, phosphorus, and albumin levels. The relationship between ionized calcium and plasma pH is reciprocal (increase in pH decreases percent of Ca++ ionized). Patients with alkalosis for example may show signs of hypocalcemia despite a normal total calcium level. Changes in albumin will affect total serum calcium without changing the level of free calcium. (decreased albumin

decreased total Ca++

constant free Ca++)

Signs and symptoms: numbness with tingling of fingers, extremities and circumoral region

hyperactive reflexes,

muscle cramps,

carpopedal spasm,

stridor,

tetany,

seizures. Positive Trousseau's sing (carpal spasm with BP cuff) and positive Chvostek's sign (contraction of facial and eyelid muscles when facial nerve tapped). Cardiac effects include decreased myocardial contractility and heart failure.

History and risk factors:
1) Decreased ionized calcium: alkalosis; administration of large quantities of citrated blood (may bind calcium); hemodilution (volume replacement etc.)
2) Increased calcium loss in body fluids: certain diuretics.
3) Decreased intestinal absorption: decreased intake; impaired vitamin D metabolism (renal failure); chronic diarrhea, post-gastrectomy.
4) Hypoparathyroidism: congenital or acquired.
5) Hyperphosphatemia: e.g. renal failure. When hypocalcemia persists, it is best to delay calcium supplementation until the serum phosphate level is below 6 mg/dL to reduce the risk of metastatic calcification.
6) Hypomagnesemia (decreased PTH action and release). Chronic alcoholism; acute pancreatitis. Hypocalcemia is difficult to correct without first normalizing the serum magnesium concentration.

Diagnostic tests:
-Total serum calcium may be less than 8.5 mg/dl. Serum calcium levels should be evaluated with serum albumin. For every 1.0 mg/dL drop in serum albumin, there is a 0.8 - 1.0 mg/dL drop in the total calcium level.
-Ionized calcium will be less than 4.2 mg/dL. Symptoms of hypocalcemia usually occur when ionized levels fall to <2.5 mg/dL.
-Parathyroid hormone: decreased levels occur in hypoparathyroidism.
-Magnesium and phosphorus levels: may be checked to indentify potential causes of hypocalcemia.

Treatment should be based on:
(1) Symptoms present: Paresthesias, tetany, carpopedal spasm, seizures
(2) Signs: Chvosek's or Trousseau's signs, impaired cardiac contractility, prolongation of the QT interval, bradycardia).
(3) Absolute level of calcium
(4) Rate of decrease (e.g. acute versus chronic decrease).

The therapeutic approach and management of hypocalcemia depends largely on the severity of symptoms and the underlying cause. In patients with asymptomatic hypocalcemia, it is important to verify with repeat measurement (ionized or total calcium corrected for serum albumin).

Calcium Conversions:
Calcium Chloride	1 gram (10ml) = 273 mg elemental calcium = 13.6 mEq = 6.8 mmol.	20mg of elemental calcium per mEq. 0.5 mmol of elemental calcium = 1.0 mEq.
Calcium Gluconate	1 gram (10ml) = 93 mg elemental calcium = 4.65 mEq = 2.325 mmol.	20mg of elemental calcium per mEq. 0.5 mmol of elemental calcium = 1.0 mEq.
Example conversion:	0.075 mmol elemental calcium/kg/hr = 0.15 mEq/kg/hr = 3 mg/kg/hr.

Vitamin D: Reference Intakes / RDA

Source: http://ods.od.nih.gov/factsheets/vitamind/

Intake reference values for vitamin D and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of The National Academies (formerly National Academy of Sciences). DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and gender, include:

Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy people.
Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.
Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.

The FNB established an RDA for vitamin D representing a daily intake that is sufficient to maintain bone health and normal calcium metabolism in healthy people. RDAs for vitamin D are listed in both International Units (IUs) and micrograms (mcg); the biological activity of 40 IU is equal to 1 mcg (Table 2). Even though sunlight may be a major source of vitamin D for some, the vitamin D RDAs are set on the basis of minimal sun exposure.

Table 2: **Recommended Dietary Allowances (RDAs) for Vitamin D**
Age	Male	Female	Pregnancy	Lactation
0–12 months*	400 IU (10 mcg)	400 IU (10 mcg)
1–13 years	600 IU (15 mcg)	600 IU (15 mcg)
14–18 years	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)
19–50 years	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)	600 IU (15 mcg)
51–70 years	600 IU (15 mcg)	600 IU (15 mcg)
>70 years	800 IU (20 mcg)	800 IU (20 mcg)

Calcium Supplementation Based on Age

Source: http://ods.od.nih.gov/factsheets/Calcium-QuickFacts/

The amount of calcium you need each day depends on your age. Average daily recommended amounts are listed below in milligrams (mg):

Birth to 6 months	200 mg
Infants 7–12 months	260 mg
Children 1–3 years	700 mg
Children 4-8 years	1,000 mg
Children 9–13 years	1,300 mg
Teens 14–18 years	1,300 mg
Adults 19–50 years	1,000 mg
Adult men 51–70 years	1,000 mg
Adult women 51–70 years	1,200 mg
Adults 71 years and older	1,200 mg
Pregnant and breastfeeding teens	1,300 mg
Pregnant and breastfeeding adults	1,000 mg

Upper limits - calcium:
Source: http://ods.od.nih.gov/factsheets/Calcium-QuickFacts/

The safe upper limits for calcium are listed below. Most people do not get amounts above the upper limits from food alone; excess intakes usually come from the use of calcium supplements. Surveys show that some older women in the United States probably get amounts somewhat above the upper limit since the use of calcium supplements is common among these women.

Birth to 6 months	1,000 mg
Infants 7-12 months	1,500 mg
Children 1-8 years	2,500 mg
Children 9-18 years	3,000 mg
Adults 19-50 years	2,500 mg
Adults 51 years and older	2,000 mg
Pregnant and breastfeeding teens	3,000 mg
Pregnant and breastfeeding adults	2,500 mg

References:

1] Goltzman D. Treatment of hypocalcemia. http://www.uptodate.com/home/index.html. Accessed 05/01/2011.

2] 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation. 2005;112:IV-121-IV-125. Accessed - revisited: 05/01/11.
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-121

Disclaimer

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer