HYPOCALCEMIA HYPERCALCEMIA

Definition Lower than 8.6 mg/dl Higher than 10.2 mg/dl

Causes LOW CALCIUM Hyperparathyroidism

Low Parathyroid Hormone Malignant tumors
Oral intake inadequate Thiazide diuretic - potentiate the action of PTH on the
Wound Drainage kidneys, reducing urinary calcium excretion
Celiac Disease, Crohn’s Disease Vitamin A and D intoxication
Acute Pancreatitis Chronic lithium use and theophylline toxicity
Low Vitamin D intake Hypophosphatemia
Chronic Kidney Disease Kidney disease (decreased excretion)
Increased phosphorus level
Using Medications
Mobility Issues
Clinical Manifestations Tetany Hypercalcemia reduces neuromuscular excitability because it
most characteristics manifestation suppresses activity at the myoneural junction
Caused by increased neural excitability by decreasing the
threshold needed for the activation of neurons Cardiovascular:
Cardiovascular: Tachycardia in early phase
Bradycardia Bradycardia in late phase that can lead to cardiac arrest
Hypotension Increased BP
Diminished peripheral pulses bounding, full peripheral pulses
Impaired clotting time
Respiratory
Gastrointestinal: Ineffective respiratory movement as a result of
Increase motility profound skeletal muscle weakness
Hyperactive bowel sounds Neuromuscular:
Cramping Profound muscle weakness
Diarrhea Diminished or absent DTR
Disorientation, lethargy, coma
Respiratory:
Bronchospasms Gastrointestinal:
Respiratory failure due to tetany and seizure Decreased motility
Hypoactive bowel sounds
Neuromuscular: Distention
Irritable skeletal muscles Constipation
Twitching, cramping, seizures
Carpopedal spasms
Paresthesia
Hyperactive DTR
Anxiety, irritability
(+) Trousseau Sign - Carpopedal spasm induced by
inflating a BP cuff above the systolic BP
 (+) Chvostek Sign - Contraction of the facial muscle
elicited in response to light tap over facial nerve
Laboratory Findings ECG Changes:
Prolonged ST, QT interval
Management Parenteral Calcium Salt
Calcium gluconate and calcium chloride
 Calcium chloride has higher calcium content but
is not commonly used
 Irritating if infiltrated, can cause necrosis or
cellulitis
 Caution for pt’s receiving digitalis - Can cause
digoxin toxicity
 Do not use 0.9 NaCl - Increase renal calcium loss
 No to solutions containing phosphates or
bicarbonates - Can cause precipitation
 Can cause postural/orthostatic hypotension -
Bedrest during infusion, BP monitoring
 Too rapid administration can cause cardiac arrest
 Should be diluted in D5W and given slow IV bolus
or slow IV infusion using pump
Increase calcium diet
1000 – 1500 mg daily
Milk products, green leafy vegetables, canned salmon,
canned sardines, fresh oysters, tofu, soymilk
Vit D Therapy - Increase calcium absorption in GIT
Nursing Management Seizure precaution
Quiet environment
Maintain patent Airway - Laryngospasm
Safety – Risk for bone fractures
Foods high in Calcium
Avoid alcohol and caffeine - Inhibits absorption
Smoking increases urinary excretion of calcium
Avoid laxatives or antacids containing phosphorus –
decreases absorption
ECG Changes:
Shortened ST segment
Widened T Wave
IV administration of 0.9% sodium chloride solution
To dilute calcium and to promote calcium excretion
Administering IV phosphate
Furosemide - increases calcium excretion
Calcitonin - reduces bone resorption, increases the deposition
of calcium and phosphorus in the bones, and increases urinary
excretion of calcium and phosphorus
Skin testing for allergy to salmon calcitonin
given by intramuscular injection rather than
subcutaneously
For patients with cancer
surgery, chemotherapy, or radiation therapy
Corticosteroids may be used to decrease bone turnover
Bisphosphonates - inhibit osteoclast activity
(pamidronate disodium [Aredia], ibandronate sodium
[Boniva])
Mithramycin - cytotoxic antibiotic, inhibits bone
resorption
o S/E: thrombocytopenia, nephrotoxicity,
rebound hypercalcemia when discontinued,
and hepatotoxicity
Increase patient mobility
Encouraging fluids - 2.8 to 3.8 L (3 to 4 quarts) of fluid
daily
Fluids containing sodium should be given unless
contraindicated, because sodium assists with calcium
excretion
Adequate fiber in the diet
Safety precautions - altered mental status, pathologic
fractures
Assess for signs and symptoms of digitalis toxicity
Renal Calculi – complication, strain urine, monitor for
presence of flank pain
cardiac rate and rhythm are monitored for any
abnormalities